| 1. |
- Ahl, Rebecka, 1987-, et al.
(författare)
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Predicting In-Hospital and 1-Year Mortality in Geriatric Trauma Patients Using Geriatric Trauma Outcome Score
- 2017
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Ingår i: Journal of the American College of Surgeons. - : Elsevier. - 1072-7515 .- 1879-1190. ; 224:3, s. 264-269
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Geriatric Trauma Outcome Score, GTOS (= [age] + [Injury Severity Score (ISS)x2.5] + 22 [if packed red blood cells (PRBC) transfused ≤24hrs of admission]), was developed and validated as a prognostic indicator for in-hospital mortality in elderly trauma patients. However, GTOS neither provides information regarding post-discharge outcomes, nor discriminates between patients dying with and without care restrictions. Isolating the latter, GTOS prediction performance was examined during admission and 1-year post-discharge in a mature European trauma registry.Study Design: All trauma admissions ≥65years in a university hospital during 2007-2011 were considered. Data regarding age, ISS, PRBC transfusion ≤24hrs, therapy restrictions, discharge disposition and mortality were collected. In-hospital deaths with therapy restrictions and patients discharged to hospice were excluded. GTOS was the sole predictor in a logistic regression model estimating mortality probabilities. Performance of the model was assessed by misclassification rate, Brier score and area under the curve (AUC).Results: The study population was 1080 subjects with a median age of 75 years, mean ISS of 10 and PRBC transfused in 8.2%). In-hospital mortality was 14.9% and 7.7% after exclusions. Misclassification rate fell from 14% to 6.5%, Brier score from 0.09 to 0.05. AUC increased from 0.87 to 0.88. Equivalent values for the original GTOS sample were 9.8%, 0.07, and 0.87. One-year mortality follow-up showed a misclassification rate of 17.6%, and Brier score of 0.13.Conclusion: Excluding patients with care restrictions and discharged to hospice improved GTOS performance for in-hospital mortality prediction. GTOS is not adept at predicting 1-year mortality.
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| 2. |
- Bass, Gary Alan, 1979-, et al.
(författare)
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Techniques for Mesoappendix Transection and Appendix Resection When Performing Acute Appendectomy : Insights from the SnapAppy Group Audit
- 2022
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Ingår i: Journal of the American College of Surgeons. - : Elsevier. - 1072-7515 .- 1879-1190. ; 235:5 Suppl. 2, s. S24-S24
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Surgically managed appendicitis exhibits great heterogeneity regarding mesoappendix transection, and appendix amputation from its base. It is unclear whether a particular surgical technique provides an outcome benefit or reduces complication.Methods: We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during the SnapAppy time-bound prospective multi-institutional non-randomized observational cohort study between November 1st 2020 - August 31st 2021 at 71 centers in 14 countries. Poisson regression models were employed for investigating the association between different surgical techniques for mesoappendix as well as stump management and postoperative complication while adjusting for potential confounding.Results: A total of 2,252 patients were included in the analyses of the technique used for dividing the mesoappendix, 69% by electrocautery and 31% by energy device. 3,729 patients were included for analyses of the management of the stump. The appendix was amputated using looped ligatures in 37%, staples in 38%, and clips in 25% of cases. After adjusting for confounders, the risk of postoperative complication was reduced by 42% when an energy device was used for handling the mesoappendix [adjusted incidence rate ratio (95% CI): 0.58 (0.41-0.82), p = 0.002]; however, no difference was detected between the techniques used for dividing the appendix at its base.Conclusion: Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Energy devices are associated with a lower rate of overall complication while no differences were observed when comparing the techniques used for dividing the appendix base.
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| 3. |
- Blomberg, Hans, et al.
(författare)
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Prehospital Trauma Life Support Training of Ambulance Caregivers and the Outcomes of Traffic-Injury Victims in Sweden
- 2013
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Ingår i: Journal of the American College of Surgeons. - : Ovid Technologies (Wolters Kluwer Health). - 1072-7515 .- 1879-1190. ; 217:6, s. 1010-1019
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:There is limited evidence that the widely implemented Prehospital Trauma Life Support (PHTLS) educational program improves patient outcomes. The primary aim of this national study in Sweden was to investigate the association between regional implementation of PHTLS training and mortality after traffic injuries.STUDY DESIGN:We extracted information from the Swedish National Patient Registry and the Cause of Death Registry on victims of motor-vehicle traffic injuries in Sweden from 2001 to 2004 (N = 28,041). During this time period, PHTLS training was implemented at a varying pace in different regions. To control for other influences on patient outcomes related to regional and hospital-level effects, such as variations in performance of trauma care systems, we used Bayesian hierarchical regression models to estimate odds ratios for prehospital mortality and 30-day mortality after hospital admission. We also controlled for the calendar year for each injury to account for period effects. We analyzed the time to death after hospital admission and time to return to work using Cox's proportional hazards frailty models.RESULTS:After multivariable adjustment, the odds ratio for prehospital mortality with PHTLS-trained prehospital staff was 1.54 (95% credibility interval, 1.07-2.13). For 30-day mortality among those surviving to hospital admission, the odds ratio was 0.85 (95% credibility interval, 0.45-1.48). There was no association between PHTLS training and time to death (hazard ratio = 0.99; 95% CI, 0.85-1.14) or time to return to work (hazard ratio = 0.98; 95% CI, 0.92-1.05).CONCLUSIONS:In this observational study, the implementation of PHTLS training did not appear to be associated with reduced mortality or ability to return to work after motor-vehicle traffic injuries.
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| 4. |
- Briel, J W, et al.
(författare)
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Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: Gastric pull-up versus colon interposition
- 2004
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Ingår i: Journal of the American College of Surgeons. - : Ovid Technologies (Wolters Kluwer Health). - 1879-1190 .- 1072-7515. ; 198:4, s. 536-541
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Reports of esophageal anastomotic complications often involve more gastric than colonic reconstructions and are incomplete because of fragmented followup by physicians unfamiliar with the surgical procedure. STUDY DESIGN: Three hundred ninety-three consecutive esophagectomy patients had prevalence and risk factors determined for graft ischemia and anastomotic leak; 363 of these patients followed for more than I month (median 15 months) had prevalence and risk factors determined for anastomotic stricture. RESULTS: Conduit ischemia occurred in 36 (9.2%) and anastomotic leak in 43 patients (10.9%). Risk factor for ischemia was comorbid conditions requiring therapy (Odds ratio [OR]: 2.2 [95% CI 1.1-4.3]), and for leak were ischemia (OR: 5.5 [95% CI 2.5-12. 1]), neoadjuvant therapy (OR: 2.2 [95% CI 1.1-4-5]), and comorbid conditions (OR: 2.1 [95% Cl 1.1-3.9]). A stricture developed in 80 patients (22.0%). Risk factors were ischemia (OR: 4.4 [95% Cl 2.0-9.6]), anastomotic leak (OR: 3.8 [95% C11.9-7.6]), and increasing preoperative weight (p = 0.022). The prevalence of ischemia was similar after gastric (10.4%) versus colonic (7.4%) reconstruction; leak and stricture were more common (14.3% versus 6.1%, p = 0.013, 31.3% versus 8.7%, p < 0.000 1, respectively) and strictures were more severe (11.2% versus 2%, p = 0.00 1) after gastric pull-up. Patients free of ischemia and leak who developed stricture were more likely to have had a gastric pull-up (25% versus 7%, p < 0. 000 1). Dilatation was effective treatment in 93% of patients. CONCLUSIONS: After esophagectomy 10% of patients will develop conduit ischemia or an anastomotic leak and 22% will develop anastornotic stricture. Anastomotic leak and strictures are more common and the strictures are more severe after gastric pull-up compared with colon interposition. Dilatation is a safe and effective treatment.
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| 5. |
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| 6. |
- Davis, Catherine H., et al.
(författare)
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Impact of Neoadjuvant Therapy for Pancreatic Cancer : Transatlantic Trend and Postoperative Outcomes Analysis
- 2024
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Ingår i: Journal of the American College of Surgeons. - : LIPPINCOTT WILLIAMS & WILKINS. - 1879-1190 .- 1072-7515. ; 238:4, s. 613-621
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The introduction of modern chemotherapy a decade ago has led to increased use of neoadjuvant therapy (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC). A recent North American study demonstrated increased use of NAT and improved operative outcomes in patients with PDAC. The aims of this study were to compare the use of NAT and short-term outcomes in patients with PDAC undergoing pancreatoduodenectomy (PD) among registries from the US and Canada, Germany, the Netherlands, and Sweden. STUDY DESIGN: Databases from 2 multicenter (voluntary) and 2 nationwide (mandatory) registries were queried from 2018 to 2020. Patients undergoing PD for PDAC were compared based on the use of upfront surgery vs NAT. Adoption of NAT was measured in each country over time. Thirty-day outcomes, including the composite measure (ideal outcomes), were compared by multivariable analyses. Sensitivity analyses of patients undergoing vascular resection were performed. RESULTS: Overall, 11,402 patients underwent PD for PDAC with 33.7% of patients receiving NAT. The use of NAT increased steadily from 28.3% in 2018 to 38.5% in 2020 (p < 0.0001). However, use of NAT varied widely by country: the US (46.8%), the Netherlands (44.9%), Sweden (11.0%), and Germany (7.8%). On multivariable analysis, NAT was significantly (p < 0.01) associated with reduced rates of serious morbidity, clinically relevant pancreatic fistulae, reoperations, and increased ideal outcomes. These associations remained on sensitivity analysis of patients undergoing vascular resection. CONCLUSIONS: NAT before PD for pancreatic cancer varied widely among 4 Western audits yet increased by 26% during 3 years. NAT was associated with improved short-term outcomes.
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| 7. |
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| 8. |
- Forssten, Maximilian P., 1996-, et al.
(författare)
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Adverse Outcomes after Pelvic Fracture in Geriatric Patients : The Critical Role of Frailty
- 2023
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Ingår i: Journal of the American College of Surgeons. - : Lippincott Williams & Wilkins. - 1072-7515 .- 1879-1190. ; 237:5, s. S557-S557
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Pelvic fractures among the elderly are associated with an increased risk of adverse outcomes. Frailty, a condition of depleted physical reserves which increases with age, is likely a contributing factor for such unfavorable events. We endeavored to describe the association between frailty, measured using the Ortho-pedic Frailty Score (OFS), and adverse outcomes in geriatric pelvic fracture patients.Methods: All geriatric (≥65yrs) patients registered in the 2013 to 2019 TQIP database with an isolated pelvic fracture following blunt trauma were considered for inclusion. An isolated pelvic fracture was defined as any fracture in the ilium, ischium, pubis, sacrum, coccyx, or acetabulum with an AIS ≤1 in all other regions except for abdominal and lower extremity. Patients were categorized as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). Poisson regression models were employed to determine the association between the OFS and adverse outcomes adjusting for confounders including angiographical and surgical interventions.Results: A total of 66,404 patients met inclusion criteria, of whom 52% were classified as non-frail, 32% as pre-frail, and 16% as frail. Compared to non-frail patients, frail patients exhibited 88% increased risk of in-hospital mortality [adjusted IRR (95% CI): 1.88 (1.54-2.30), p<0.001], a 25% increased risk of composite complications [adjusted IRR (95% CI): 1.25 (1.10-1.42), p<0.001], a 56% increased risk of failure to rescue [adjusted IRR (95% CI): 1.56 (1.14-2.14), p=0.006].Conclusion: Frail geriatric patients suffering a pelvic fracture have disproportionately increased risk for complications, mortality, and failure-to-rescue. Additional measures are required to mitigate adverse events in this vulnerable population.
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| 9. |
- Gannerdahl, Per E., et al.
(författare)
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Computerizedvectorcardio-graphy for improved perioperative cardiac monitoring in vascularsurgery
- 1996
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Ingår i: Journal of the American College of Surgeons. - : Elsevier. - 1072-7515 .- 1879-1190. ; 182:6, s. 530-536
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Postoperative cardiac complications occur frequently after noncardiac operations in high-risk patients. Routine cardiac monitoring is usually done by electrocardiographic (ECG) methods. The present analysis shows that computerizedvectorcardiography (VCG) is superior to traditional ECG monitoring in predicting postoperative cardiac complications.STUDY DESIGN:Thirty-eight patients scheduled for abdominal aortic operations were monitored intraoperatively and for 48 hours postoperatively using VCG. These data were analyzed in a blinded fashion, and compared to cardiac outcome and regularly calculated 12-lead ECGs.RESULTS:Thirteen patients suffered from cardiac events: myocardial infarction (n = 3), cardiac death (n = 1), recurrent myocardial ischemia (n = 1), arrhythmias (n = 2), congestive heart failure (n = 2), and arrhythmias combined with congestive heart failure (n = 4). Thirty of 38 patients had ischemia recorded on their VCG, including all 13 patients with cardiac events. Only seven of the 13 patients had ischemic changes on the V5-lead alone and ten on the three leads II, V4, V5, yielding a sensitivity of 54 percent (V5), 77 percent (II, V4, V5) and 100 percent (VCG). Signs of ischemia appeared 400 +/- 690 (mean plus or minus standard deviation) minutes earlier (median 78 minutes, with a range of zero to 2,284 minutes), and never later on the VCG compared to the three leads II, V4, V5.CONCLUSIONS:Vectorcardiography in this risk group shows increased sensitivity in predicting perioperative cardiac complications and earlier ischemia detection than the most sensitive scalar leads. Vectorcardiography substantially improves the possibility of earlier intervention, potentially reducing the incidence of postoperative cardiac complications.
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| 10. |
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| 11. |
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| 12. |
- Ghareeb, Waleed M., et al.
(författare)
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Deep Neural Network for the Prediction of KRAS Genotype in Rectal Cancer
- 2022
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Ingår i: Journal of the American College of Surgeons. - 1879-1190. ; 235:3, s. 482-493
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: KRAS mutation can alter the treatment plan after resection of colorectal cancer. Despite its importance, the KRAS status of several patients remains unchecked because of the high cost and limited resources. This study developed a deep neural network (DNN) to predict the KRAS genotype using hematoxylin and eosin (H&E)-stained histopathological images. STUDY DESIGN: Three DNNs were created (KRAS_Mob, KRAS_Shuff, and KRAS_Ince) using the structural backbone of the MobileNet, ShuffleNet, and Inception networks, respectively. The Cancer Genome Atlas was screened to extract 49,684 image tiles that were used for deep learning and internal validation. An independent cohort of 43,032 image tiles was used for external validation. The performance was compared with humans, and a virtual cost-saving analysis was done. RESULTS: The KRAS_Mob network (area under the receiver operating curve [AUC] 0.8, 95% CI 0.71 to 0.89) was the best-performing model for predicting the KRAS genotype, followed by the KRAS_Shuff (AUC 0.73, 95% CI 0.62 to 0.84) and KRAS_Ince (AUC 0.71, 95% CI 0.6 to 0.82) networks. Combing the KRAS_Mob and KRAS_Shuff networks as a double prediction approach showed improved performance. KRAS_Mob network accuracy surpassed that of two independent pathologists (AUC 0.79 [95% CI 0.64 to 0.93], 0.51 [95% CI 0.34 to 0.69], and 0.51 (95% CI 0.34 to 0.69]; p < 0.001 for all comparisons). CONCLUSION: The DNN has the potential to predict the KRAS genotype directly from H&E-stained histopathological slide images. As an algorithmic screening method to prioritize patients for laboratory confirmation, such a model might possibly reduce the number of patients screened, resulting in significant test-related time and economic savings.
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| 13. |
- Goolsby, Craig, et al.
(författare)
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The Untrained Publics Ability to Apply the Layperson Audiovisual Assist Tourniquet vs a Combat Application Tourniquet: A Randomized Controlled Trial
- 2023
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Ingår i: Journal of the American College of Surgeons. - : LIPPINCOTT WILLIAMS & WILKINS. - 1072-7515 .- 1879-1190. ; 236:1, s. 178-186
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although the Stop the Bleed campaigns impact is encouraging, gaps remain. These gaps include rapid skill decay, a lack of easy-to-use tourniquets for the untrained public, and training barriers that prevent scalability. A team of academic and industry partners developed the Layperson Audiovisual Assist Tourniquet (LAVA TQ)& mdash;the first audiovisual-enabled tourniquet for public use. LAVA TQ addresses known tourniquet application challenges and is novel in its design and technology. STUDY DESIGN: This study is a prospective, randomized, superiority trial comparing the ability of the untrained public to apply LAVA TQ to a simulated leg vs their ability to apply a Combat Application Tourniquet (CAT). The study team enrolled participants in Boston, MA; Frederick, MD; and Linkoping, Sweden in 2022. The primary outcome was the proportion of successful applications of each tourniquet. Secondary outcomes included: mean time to application, placement position, reasons for failed application, and comfort with the devices. RESULTS: Participants applied the novel LAVA TQ successfully 93% (n = 66 of 71) of the time compared with 22% (n = 16 of 73) success applying CAT (relative risk 4.24 [95% CI 2.74 to 6.57]; p < 0.001). Participants applied LAVA TQ faster (74.1 seconds) than CAT (126 seconds ; p < 0.001) and experienced a greater gain in comfort using LAVA TQ than CAT. CONCLUSIONS: The untrained public is 4 times more likely to apply LAVA TQ correctly than CAT. The public also applies LAVA TQ faster than CAT and has more favorable opinions about its usability. LAVA TQs highly intuitive design and built-in audiovisual guidance solve known problems of layperson education and skill retention and could improve public bleeding control. (c) 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
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| 14. |
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| 15. |
- Kiwanuka, Elizabeth, et al.
(författare)
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Comparison of Healing Parameters in Porcine Full-Thickness Wounds Transplanted with Skin Micrografts, Split-Thickness Skin Grafts, and Cultured Keratinocytes
- 2011
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Ingår i: Journal of the American College of Surgeons. - : Ovid Technologies (Wolters Kluwer Health). - 1072-7515 .- 1879-1190. ; 213:6, s. 728-735
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Transplantation of skin micrografts (MGs), split-thickness skin grafts (STSGs), or cultured autologous keratinocytes (CKs) enhances the healing of large full-thickness wounds. This study compares these methods in a porcine wound model, investigating the utility of micrograft transplantation in skin restoration. STUDY DESIGN: Full-thickness wounds were created on Yorkshire pigs and assigned to one of the following treatment groups: MGs, STSGs, CKs, wet nontransplanted, or dry nontransplanted. Dry wounds were covered with gauze and the other groups' wounds were enclosed in a polyurethane chamber containing saline. Biopsies were collected 6, 12, and 18 days after wounding. Quantitative and qualitative wound healing parameters including macroscopic scar appearance, wound contraction, neoepidermal maturation, rete ridge formation, granulation tissue thickness and width, and scar tissue formation were studied. RESULTS: Transplanted wounds scored lower on the Vancouver Scar Scale compared with nontransplanted wounds, indicating a better healing outcome. All transplanted wounds exhibited significantly lower contraction compared with nontransplanted wounds. Wounds transplanted with either MGs, STSGs, or CKs showed a significant increase in re-epithelialization compared with nontransplanted wounds. Wounds transplanted with MGs or STSGs exhibited improved epidermal healing compared with nongrafted wounds. Furthermore, transplantation with STSGs or MGs led to less scar tissue formation compared with the nontransplanted wounds. No significant impact on scar formation was observed after transplantation of CKs. CONCLUSIONS: Qualitative and quantitative measurements collected from full-thickness porcine wounds show that transplantation of MGs improve wound healing parameters and is comparable to treatment with STSGs.
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| 16. |
- Kiwanuka, Elizabeth, et al.
(författare)
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Connective tissue growth factor enhances keratinocyte adhesion to fibronectin and promotes migration through integrin alpha5/beta1
- 2012
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Ingår i: Journal of the American College of Surgeons. - : Ovid Technologies (Wolters Kluwer Health). - 1072-7515 .- 1879-1190. ; 215:3, s. S81-S82
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: We have previously shown that connective tissue growth factor (CTGF) promotes keratinocyte migration during re-epithelialization. In this study, we investigated whether the CTGF-driven migration involved integrin alpha-5/beta-1 - the principal ligand for fibronectin (FN).Methods: Adhesions assays were performed by coating wells with 10 ug/mL FN or phosphate buffered saline (PBS). Keratinocytes were seeded in the presence or absence of 200 ng/mL CTGF, 5 mmol/L EDTA, 10 mmol/L Mg2+, 10 ug/mL anti-integrin alpha-5/beta-1-blocking antibody. Chemotaxsis assays were performed using a modified Boyden chamber. Keratinocytes were pre-incubated with alpha-5/beta-1-antibodies or mouse-IgG for 30 minute, and migration in the absence or presence of 200 ng/mL CTGF was measured. Cells were stained and absorbance was measured at 570 nm. A value of 1 was assigned to untreated cells.Results: Cell adhesion increased 1.5 ± 0.3 folds in wells coated with FN compared to PBS. CTGF enhanced cell adhesion 2.1 ± 0.3 folds, while EDTA reduced CTGF mediated cell adhesion to baseline (1.1 ± 0.2). The addition of the divalent cation Mg2+ restored CTGF-induced adhesion, indicating involvement of integrins. Integrin alpha-5/beta-1-blocking antibodies reversed CTGF-enhanced binding (1.1 ± 0.2). Consistent with the cell adhesion data, CTGF-induced migration was reduced to 1.5 ± 0.3 by anti-integrin alpha-5/beta-1 antibodies compared to the 2.0 ± 0.6 fold increase seen with 200 ng/mL CTGF.
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| 17. |
- Ljungqvist, Olle, 1954-, et al.
(författare)
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Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance
- 1994
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Ingår i: Journal of the American College of Surgeons. - 1072-7515 .- 1879-1190. ; , s. 329-336
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Tidskriftsartikel (refereegranskat)abstract
- In severe catabolic states, such as burn injury, sepsis and accidental injury, a state of marked insulin resistance is encountered. Insulin resistance is also present after elective surgical treatment, more pronounced with increasingly greater magnitude of operation performed. Results of recent animal experiments have shown that even short periods of food deprivation, reducing carbohydrate reserves, alter responses to stress. This notion resulted in our questioning the rationale of carbohydrate depletion associated with overnight preoperative fasting. Twelve patients undergoing elective open cholecystectomy were randomly given no infusion (control group) or 5 milligrams per kilogram per minute of glucose infusion (glucose group) during preoperative overnight fasting. Insulin sensitivity (M value, milligram per kilogram per minute) was determined using the hyperinsulinemic normoglycemic clamp (plasma insulin level, 65 microunits per milliliter and blood glucose level, 4.5 millimoles per liter) before and the first postoperative day. Preoperative insulin sensitivity was similar in the two groups. Postoperatively, M values decreased by 55±3 percent (control group) and by 32±5 percent (glucose group) (p<0.01). Plasma levels of insulin, c- peptide, glucagon, growth hormone, catecholamines and cortisol in connection with clamps were similar in both groups preoperatively and postoperatively. The present results indicate that active preoperative carbohydrate preservation may improve postoperative metabolism because postoperative occurrence of insulin resistance was reduced with preoperative glucose infusion.
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| 18. |
- Novik, Bengt, et al.
(författare)
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Association of Mesh and Fixation Options with Reoperation Risk after Laparoscopic Groin Hernia Surgery : A Swedish Hernia Registry Study of 25,190 Totally Extraperitoneal and Transabdominal Preperitoneal Repairs.
- 2022
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Ingår i: Journal of the American College of Surgeons. - 1072-7515 .- 1879-1190. ; 234:3, s. 311-325
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: International guidelines concerning mesh and mesh fixation options in laparoscopic totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. We hypothesized that the value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The current registry-based nationwide cohort study compared different mesh/fixation combinations for relative risks for reoperation after TEP and TAPP groin hernia repair.STUDY DESIGN: All TEP and TAPP registered in the Swedish Hernia Registry 2005 to 2017 with standard polypropylene (StdPPM) or lightweight (LWM) flat mesh, having tack, fibrin glue, or no fixation, were included. The endpoint was reoperation due to recurrence as of December 31, 2018. Multivariable Cox regression rendered relative risk differences between the exposures, expressed as hazard ratios (HR) with 95% CIs.RESULTS: Of 25,190 repairs, 924 (3.7%) were later reoperated for recurrence. The lowest, mutually equivalent, reoperation risks were associated with StdPPM without fixation (HR 1), StdPPM with metal tacks (HR 0.8, CI 0.4 to 1.4), StdPPM with fibrin glue (HR 1.1, CI 0.7 to 1.6), and LWM with fibrin glue (HR 1.2, CI 0.97 to 1.6). Except for with fibrin glue, LWM correlated with increased risk, whether affixed with metal (HR 1.7, CI 1.1 to 2.7), or absorbable tacks (HR 2.4, CI 1.8 to 3.1), or deployed without fixation (HR 2.0, CI 1.6 to 2.6).CONCLUSIONS: With StdPPM, neither mechanical nor glue fixation seemed to improve outcomes. Thus, for this mesh category, we recommend nonfixation. With LWM, we recommend fibrin glue fixation, which was the only LWM alternative on par with nonaffixed StdPPM.
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| 19. |
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| 20. |
- Resch, Timothy, et al.
(författare)
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The evolution of Z stent-based stent-grafts for endovascular aneurysm repair: a life-table analysis of 7.5-year followup.
- 2002
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Ingår i: Journal of the American College of Surgeons. - 1879-1190. ; 194:1 Suppl, s. 74-78
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of this study was to analyze the impact of stent-graft design and operator skills on outcomes after endovascular abdominal aortic aneurysm repair. STUDY DESIGN: One hundred sixty-four patients (mean age 71 years) underwent stent-graft repair. Patients were treated with four different types of stent-graft: first-generation (n = 58) and second-generation (n = 17) Ivancev-Malmö monoiliac stent-grafts (IM I and IM II, respectively) combined with femoral-femoral crossover, Chuter bifurcated stent-graft (n = 15), and the Zenith stent-graft (n = 74). Patients underwent digital subtraction angiography and contrast CT preoperatively and were then followed with CT scans postoperatively. Recently, followup was changed to CT scanning at 1 month and 1 year postoperatively and annually thereafter. Ultrasonographic duplex scanning substitutes in the remaining followup. Changes in aneurysm diameters and occurrence of endoleaks were recorded. Short- and midterm mortality and complications and postoperative secondary interventions were recorded, and life-table analysis for intervention-free stent-graft survival was calculated. RESULTS: Immediate and late conversions and 30-day mortality were reduced for second- (IM II and Zenith) compared with first-generation stent-grafts (IM I and Chuter). Stent-graft migrations occurred only with the IM I and Chuter stent-grafts. Type I endoleak was significantly more common in first-generation stent-grafts. First-generation stent-grafts required significantly more secondary interventions than second-generation stent-grafts up to 30 months postoperatively. CONCLUSION: Enhanced stent-graft design has improved the probability of stent-graft success after endovascular abdominal aortic aneurysm repair. Better technical skills and increased use of intraoperative adjunctive procedures may also have contributed to improved results.
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| 21. |
- Rubinsky, AD, et al.
(författare)
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AUDIT-C Alcohol Screening Results and Postoperative Inpatient Health Care Use.
- 2012
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Ingår i: Journal of the American College of Surgeons. - : Ovid Technologies (Wolters Kluwer Health). - 1879-1190 .- 1072-7515. ; 214:3, s. 296-305
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Alcohol screening scores 5 on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) up to a year before surgery have been associated with postoperative complications, but the association with postoperative health care use is unknown. This study evaluated whether AUDIT-C scores in the year before surgery were associated with postoperative hospital length of stay, total ICU days, return to the operating room, and hospital readmission. STUDY DESIGN: This cohort study included male Veterans Affairs patients who completed the AUDIT-C on mailed surveys (October 2003 through September 2006) and were hospitalized for nonemergent noncardiac major operations in the following year. Postoperative health care use was evaluated across 4 AUDIT-C risk groups (scores 0, 1 to 4, 5 to 8, and 9 to 12) using linear or logistic regression models adjusted for sociodemographics, smoking status, surgical category, relative value unit, and time from AUDIT-C to surgery. Patients with AUDIT-C scores indicating low-risk drinking (scores 1 to 4) were the referent group. RESULTS: Adjusted analyses revealed that among eligible surgical patients (n 5,171), those with the highest AUDIT-C scores (ie, 9 to 12) had longer postoperative hospital length of stay (5.8 [95% CI, 5.06.7] vs 5.0 [95% CI, 4.75.3] days), more ICU days (4.5 [95% CI, 3.25.8] vs 2.8 [95% CI, 2.63.1] days), and increased probability of return to the operating room (10% [95% CI, 613%] vs 5% [95% CI, 46%]) in the 30 days after surgery, but not increased hospital readmission within 30 days postdischarge, relative to the low-risk group. CONCLUSIONS: AUDIT-C screening results could be used to identify patients at risk for increased postoperative health care use who might benefit from preoperative alcohol interventions.
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| 22. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Remission of Obesity-Related Sleep Apnea and Its Effect on Mortality and Cardiovascular Events After Metabolic and Bariatric Surgery : A Propensity Matched Cohort Study
- 2024
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Ingår i: Journal of the American College of Surgeons. - : Elsevier. - 1072-7515 .- 1879-1190. ; 239:2, s. 77-84
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: While obstructive sleep apnea (OSA) is common among patients with obesity and linked to cardiovascular disease, there is a lack of studies evaluating the effects of reaching remission from OSA after metabolic and bariatric surgery (MBS).STUDY DESIGN: A registry-based nationwide study including patients operated with sleeve gastrectomy or Roux-en-Y gastric bypass from 2007 until 2019 in Sweden. Patients who reached remission of OSA were compared to those who did not reach remission, and a propensity score matched control group of patients without OSA at the time of operation. Main outcome was overall mortality, secondary outcome was major cardiovascular events (MACE).RESULTS: In total, 5892 patients with OSA and 11,552 matched patients without OSA completed a 1-year follow-up and were followed for a median of 6.8 years. Remission of OSA was seen for 4334 patients (74%). Patients in remission had a lower risk for overall mortality (cumulative incidence 6.0% v. 9.1%;p<0.001) and MACE (cumulative incidence 3.4% vs 5.8%;p<0.001) at 10-years after operation compared to those who did not reach remission. The risk was similar to that of the control group without OSA at baseline (cumulative incidence for mortality 6.0%, p=0.493, for MACE 3.7%, p=0.251).CONCLUSION: The remission rate of OSA was high after MBS. This was in turn associated with reduced risk for death and MACE compared to patients who did not achieve remission reaching a similar risk seen among patients without OSA at baseline. A diligent follow-up of patients who do not reach remission remains important.
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| 23. |
- Sugawara, Toshitaka, et al.
(författare)
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Management of localized small- and large-cell pancreatic neuroendocrine carcinoma in the national cancer database
- 2023
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Ingår i: Journal of the American College of Surgeons. - : Wolters Kluwer. - 1072-7515 .- 1879-1190. ; 237:3, s. 515-524
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The role of curative-intent resection and perioperative chemotherapy for nonmetastatic pancreatic neuroendocrine carcinoma (PanNEC) remains unclear due to their biological aggressiveness and rarity. This study aimed to evaluate the association of resection and perioperative chemotherapy with overall survival for nonmetastatic PanNEC.STUDY DESIGN: Patients with localized (cT1-3, M0), small- and large-cell PanNEC were identified in the National Cancer Database from 2004 to 2017. The changing trends in terms of the annual proportions of resection and adjuvant chemotherapy were assessed. The survival of patients who received resection and those who received adjuvant chemotherapy were investigated using Kaplan-Meier estimates and Cox regression models.RESULTS: In total, 199 patients with localized small- and large-cell PanNEC were identified; 50.3% of those were resected, and 45.0% of the resected patients received adjuvant chemotherapy. Rate of resection and adjuvant treatment has trended upward since 2011. The resected group was younger, was more often treated at academic institutions, had more distal tumors, and had a lower number of small-cell PanNEC. The median overall survival was longer in the resected group compared to the unresected group (29.4 months vs 8.6 months, p < 0.001). Resection was associated with improved survival in a multivariable Cox regression model adjusting for preoperative factors (adjusted hazard ratio 0.58, 95% CI 0.37 to 0.92), while adjuvant therapy was not.CONCLUSIONS: This nationwide retrospective study suggests that resection is associated with improved survival in patients with localized PanNEC. The role of adjuvant chemotherapy needs more investigation.
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| 24. |
- Uustal Fornell, Eva K., et al.
(författare)
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Clinical consequences of anal sphincter rupture during vaginal delivery
- 1996
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Ingår i: Journal of the American College of Surgeons. - 1072-7515 .- 1879-1190. ; 183:6, s. 553-558
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Rupture of the anal sphincters at childbirth is considered rare in obstetric literature. Long-term effects are sparingly mentioned. In clinical practice, however, it is not uncommon to meet women with anal incontinence. The aim of our study was to record the incidence and to evaluate the consequences of rupture of the anal sphincter at childbirth.STUDY DESIGN:Fifty-one consecutive women with primarily sutured anal sphincter rupture and 31 women without anal sphincter rupture were prospectively studied after vaginal delivery. All were assessed clinically at 3 days, 6 weeks, and 6 months after delivery. After 6 months, all women underwent anorectal manometry and answered a questionnaire about incontinence, social function, and general health.RESULTS:The overall incidence of sphincter rupture was 2.4 percent. Significantly lower values were found for maximum anal squeeze pressure and squeeze pressure area 6 months postpartum in the women with sphincter rupture compared with those without rupture. The resting pressures did not differ between groups. Approximately 40 percent of the women in both groups had noted some fecal incontinence by 6 months postpartum. Symptoms were significantly more severe in patients with sphincter rupture.CONCLUSIONS:Anal sphincter rupture was 2.4 times as common as reported in Swedish birth statistics. The high incidence of fecal incontinence by 6 months postpartum in all women is surprising and deserves further investigation, specifically regarding occult sphincter rupture.
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| 25. |
- Yang, Liyun, 1992-, et al.
(författare)
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Impact of Procedure Type, Case Duration, and Adjunctive Equipment on Surgeon Intraoperative Musculoskeletal Discomfort
- 2020
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Ingår i: Journal of the American College of Surgeons. - : ELSEVIER SCIENCE INC. - 1072-7515 .- 1879-1190. ; 230:4, s. 554-560
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Surgeons are at high risk of developing musculoskeletal disorders. STUDY DESIGN: This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective measures, including type of procedure and equipment used. Wearable sensors and pre- and postoperation surveys were analyzed. RESULTS: Data from 116 cases (34 male and 19 female surgeons) were collected across surgical specialties. Surgeons reported increased pain in the neck, upper, and lower back both during and after operations. High-stress intraoperative postures were also revealed by the real-time measurement in the neck and back. Surgical duration also impacted physical pain and fatigue. Open procedures had more stressful physical postures than laparoscopic procedures. Loupe usage negatively impacted neck postures. CONCLUSIONS: This study highlights the fact that musculoskeletal disorders are common in surgeons and characterizes surgeons' intraoperative posture as well as surgeon pain and fatigue across specialties. Defining intraoperative ((C) 2020 The Author(s). Published by Elsevier Inc. on behalf of the American College of Surgeons.
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| 26. |
- Zebley, James Andrew, et al.
(författare)
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Racial Disparities in the Placement of Intracranial Monitoring : A TQIP Analysis
- 2022
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Ingår i: Journal of the American College of Surgeons. - : Elsevier. - 1072-7515 .- 1879-1190. ; 235:5 Suppl. 2, s. S96-S96
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear.Methods: We queried the Trauma Quality Improvement Project (TQIP) database from 2017-2019 and included patients ≥16 years old, with blunt severe TBI. Exclusion criteria was no recorded race, those without signs of life, had length of stay <1 day and AIS=6 in any body region. Variables included demographic, clinical, and outcome characteristics. The primary outcome was probability of ICP-monitor placement. We calculated incidence rate ratios for ICP monitor placement using a Poisson regression model to adjust for confounders.Results: A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 Native American, and 796 Pacific Islander. Asian and Native American patients had the highest rates of midline shift (16.5% and 16.9%). Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring [adjusted IRR 1.19 (95%CI: 1.06-1.33), p = 0.003], while Native American patients were 38% less likely [adjusted IRR 0.62 (95%CI: 0.49-0.79), p < 0.001], compared with White patients, respectively. No differences were detected between White and Black patients.Conclusion: ICP monitoring use differs significantly by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.
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| 27. |
- Zebley, James A., et al.
(författare)
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Racial Disparity in Placement of Intracranial Pressure Monitoring : A TQIP Analysis
- 2023
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Ingår i: Journal of the American College of Surgeons. - : Elsevier. - 1072-7515 .- 1879-1190. ; 236:1, s. 81-92
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear.STUDY DESIGN: We queried the TQIP database from 2017 to 2019 and included patients 16 years or older, with blunt severe TBI, defined as a head abbreviated injury score 3 or greater. Exclusion criteria were missing race, those without signs of life on admission, length of stay 1 day or less, and AIS of 6 in any body region. The primary outcome was ICP monitor placement, which was calculated using a Poisson regression model with robust SEs while adjusting for confounders.RESULTS: A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 American Indian, and 796 Native Hawaiian or Other Pacific Islander. Asian and American Indian patients had the highest rates of midline shift (16.5% and 16.9%). Native Hawaiian or Other Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring (adjusted incident rate ratio 1.19; 95% CI 1.06 to 1.33; p = 0.003], and American Indian patients were 38% less likely (adjusted incident rate ratio 0.62; 95% CI 0.49 to 0.79; p < 0.001), compared with White patients, respectively. No differences were detected between White and Black patients.CONCLUSIONS: ICP monitoring use differs by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.
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| 28. |
- Zöller, Bengt, et al.
(författare)
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Shared and Nonshared Familial Susceptibility to Surgically Treated Inguinal Hernia, Femoral Hernia, Incisional Hernia, Epigastric Hernia, and Umbilical Hernia.
- 2013
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Ingår i: Journal of the American College of Surgeons. - : Ovid Technologies (Wolters Kluwer Health). - 1879-1190 .- 1072-7515. ; 217:2, s. 289-289
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Tidskriftsartikel (refereegranskat)abstract
- The familial risk of abdominal wall hernia (AWH) is largely unknown. In addition, it is unknown whether inguinal hernia (IH), femoral hernia (FH), incisional hernia (INH), epigastric hernia (EH), and umbilical hernia (UH) share familial susceptibility. The aim of this nationwide study was to determine the familial risks of concordant AWH (same disease in proband and exposed relative) and discordant AWH (different disease in proband and exposed relative).
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| 29. |
- Geier, Christian, et al.
(författare)
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Paleovegetation and paleoclimate inferences of the early late Sarmatian palynoflora from the Gleisdorf Fm. at Gratkorn, Styria, Austria
- 2022
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Ingår i: Review of Palaeobotany and Palynology. - Amsterdam : Elsevier. - 0034-6667 .- 1879-0615. ; 307, s. 1-65
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Tidskriftsartikel (refereegranskat)abstract
- The Gleisdorf Formation (Fm.) deposits in the clay pit at Gratkorn, Styria, Austria, are dated to 12.2–12 Ma,and are of late Middle Miocene age (late Serravallian or Sarmatian). To reconstruct the paleovegetation and estimate the paleoclimate at this important vertebrate site, the palynoflora close to the boundary between the vertebrate-bearing layers of the Gratkorn Fm. and the overlying limnic clay deposits of the Gleisdorf Fm. was investigated. Using the single-grain method, 140 palynomorphs were identified. The palynoflora suggests that the paleovegetation was characterised by well-drained lowland and upland forests, riparian forest, and swamp forests. Depending on the dominating tree species, lowland and upland forests might have had closed or more open canopies. Open habitats included wet meadows and shrublands. In addition, conifers were present in theswampy lowlands and the forested uplands. The most prominent paleoclimatic signatures of the palynoflora indicate a fully humid warm temperate climate, with hot to warm summers and cool winters (Cfa-, Cfb-climate), and a seasonal climate with cool and drier winters and hot to warm and wetter summers (Cwa-, Cwb-climate). Our results align with existing studies bordering the Styrian Basin and support the presence of subtropical to warm-temperate vegetation around Gratkorn during the Sarmatian.
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| 30. |
- Yang, Xia, et al.
(författare)
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beta-Cyclodextrin grafted polyethyleneimine hydrogel immobilizing hydrophobically modified glucose oxidase
- 2011
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Ingår i: International Journal of Biological Macromolecules. - : Elsevier BV. - 0141-8130 .- 1879-0003. ; 48:4, s. 661-666
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Tidskriftsartikel (refereegranskat)abstract
- Hydrogels which release their contents in response to glucose concentration were prepared by immobilizing glucose oxidase (GOD) into beta-cyclodextrin grafted polyethyleneimine hydrogels (PEI-beta CD hydrogel). For the tight immobilization, hydrophobically modified GOD (HmGOD) was prepared by reacting GOD with palmitic acid-N-hydroxysuccinimide ester (PA-NHS) in the molar ratio of 1:40. According to trinitrobenzene sulfonic acid (TNBS) assay, five palmitic acids were covalently attached to one GOD molecule. The activity of HmGOD was about 76% of native enzyme. The swelling ratios of HmGOD loaded hydrogels increased from about 960% to 1190% in 24 h, when glucose concentration was varied from 0 to 100 mg/dl. The % release in 48 h of fluorescein isothiocyanate dextran increased from about 53% to 89%, when glucose concentration was varied in the same range. Gluconic acid, produced by the enzymatic reaction, would protonate and swell the PEI-beta CD hydrogel, leading to a higher release.
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| 31. |
- Aleksandrova, Krasimira, et al.
(författare)
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Adult weight change and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition
- 2013
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Ingår i: European Journal of Cancer. - : Elsevier BV. - 1879-0852 .- 0959-8049. ; 49:16, s. 3526-3536
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Weight change during adult life may reflect metabolic changes and influence colorectal cancer (CRC) development, but such role is not well established. We aimed to explore the association between adult weight change (from age 20 to 50) and CRC risk. In particular, we investigated differences according to colon and rectal cancer, sex and measures of attained adiposity. Methods: We included 201,696 participants from six participating countries in the European Prospective Investigation into Cancer and Nutrition (1992-2010). During a mean follow-up of 11.2 years 2384 (1194 in men and 1190 in women) incident CRC cases occurred. Cox proportional hazard models adjusted for body mass index at age 20 and lifestyle factors at study recruitment were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: After multivariable adjustment, each kg of weight gained annually from age 20 to 50 was associated with a 60% higher risk of colon cancer (95% CI 1.20-2.09), but not rectal cancer (HR 1.13, 95% CI 0.79-1.62, P-interaction = 0.04). The higher risk of colon cancer was restricted to people with high attained waist circumference at age 50 (HR 1.82, 95% CI 1.14-2.91, P-interaction = 0.02). Results were not different in men and women (P-interaction = 0.81). Conclusion(s): Adult weight gain, as reflected by attained abdominal obesity at age 50, increases colon cancer risk in both men and women. These data underline the importance of weight management and metabolic health maintenance in early adult life years for colon cancer prevention. (C) 2013 Elsevier Ltd. All rights reserved.
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| 32. |
- Serafimovich, Natalia I., 1974-, et al.
(författare)
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Optical observations of the young supernova remnant SNR 0540-69.3 and its pulsar
- 2005
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Ingår i: Advances in Space Research. - : Elsevier BV. - 0273-1177 .- 1879-1948. ; 35:6, s. 1106-1111
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Tidskriftsartikel (refereegranskat)abstract
- We have used the ESO NTT/EMMI and VLT/FORS1 instruments to examine the LMC supernova remnant 0540-69.3 as well as its pulsar (PSR B0540-69) and pulsar-powered nebula in the optical range. Spectroscopic observations of the remnant covering the range of 3600 7350 Å centered on the pulsar produced results consistent with those of [Kirshner, R.P., Morse, J.A., Winkler, P.F., et al. The penultimate supernova in the Large Magellanic Cloud - SNR 0540-69.3. Astrophys.J. 342, 260 271, 1989.] but also revealed many new emission lines. The most important are [Ne III] λλ3869, 3967 and Balmer lines of hydrogen. In both the central part of the remnant, as well as in nearby H II regions, the [O III] temperature is higher than ˜2 × 104 K, but lower than previously estimated. For PSR B0540-69, previous optical data are mutually inconsistent: HST/FOS spectra indicate a significantly higher absolute flux and steeper spectral index than suggested by early time-resolved groundbased UBVRI photometry. We show that the HST and VLT spectroscopic data for the pulsar have ≳50% nebular contamination, and that this is the reason for the previous difference. Using HST/WFPC2 archival images obtained in various bands from the red part of the optical to the NUV range we have performed an accurate photometric study of the pulsar, and find that the spectral energy distribution of the pulsar emission has a negative slope with α=1.07-0.19+0.20. This is steeper than derived from previous UBVRI photometry, and also different from the almost flat spectrum of the Crab pulsar. We also estimate that the proper motion of the pulsar is 4.9 ± 2.3 mas year‑1, corresponding to a transverse velocity of 1190 ± 560 km s‑1, projected along the southern jet of the pulsar nebula.
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