Publications by authors named "Rifat Latifi"

229 Publications

Improving Liver Transplant Outcomes for Hepatitis C Virus Hepatocellular Carcinoma in the Direct-Acting Antiviral Therapy Era.

Transplant Proc 2022 Aug 4. Epub 2022 Aug 4.

Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York. Electronic address:

Background: Direct-acting antiviral (DAA) therapy has transformed the outcomes of liver transplant (LT) with hepatitis C virus (HCV). This study aimed to analyze the effects of DAA treatment for HCV-associated hepatocellular carcinoma (HCC) in LT.

Methods: We included patients confirmed with HCC on explant, analyzed data from United Network for Organ Sharing, and defined the pre-DAA era (2012-2013) and DAA era (2014-2016).

Results: HCV-associated HCC cases totaled 4778 (62%) during the study period. In the DAA era, the median recipient age was older and the median days on the waiting list were longer. For the donor, median age, body mass index, and the rate of HCV significantly increased in the DAA era. In pathology, the median largest tumor size was significantly higher; however, the rate of completed tumor necrosis was significant higher in the DAA era. The 3-year graft/patient survival had significantly improved in the DAA era. In multivariable analysis, the DAA era (hazard ratio, 0.79; 95% confidence interval, 0.68-0.91) had significantly affected the 3-year graft survival.

Conclusions: DAA has a significant beneficial effect on LT. In the DAA era, graft survival for HCV-associated HCC has been significantly improving.
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http://dx.doi.org/10.1016/j.transproceed.2022.03.070DOI Listing
August 2022

Mortality Risk Factors in Patients Admitted with the Primary Diagnosis of Tracheostomy Complications: An Analysis of 8026 Patients.

Int J Environ Res Public Health 2022 Jul 25;19(15). Epub 2022 Jul 25.

Department of Surgery, University of Arizona, Tucson, AZ 85721, USA.

Background: Tracheostomy is a procedure commonly conducted in patients undergoing emergency admission and requires prolonged mechanical ventilation. In the present study, the aim was to determine the prevalence and risk factors of mortality among emergently admitted patients with tracheostomy complications, during the years 2005-2014.

Methods: This was a retrospective cohort study. Demographics and clinical data were obtained from the National Inpatient Sample, 2005-2014, to evaluate elderly (65+ years) and non-elderly adult patients (18-64 years) with tracheostomy complications (ICD-9 code, 519) who underwent emergency admission. A multivariable logistic regression model with backward elimination was used to identify the association between predictors and in-hospital mortality.

Results: A total of 4711 non-elderly and 3315 elderly patients were included. Females included 44.5% of the non-elderly patients and 47.6% of the elderly patients. In total, 181 (3.8%) non-elderly patients died, of which 48.1% were female, and 163 (4.9%) elderly patients died, of which 48.5% were female. The mean (SD) age of the non-elderly patients was 50 years and for elderly patients was 74 years. The mean age at the time of death of non-elderly patients was 53 years and for elderly patients was 75 years. The odds ratio (95% confidence interval, -value) of some of the pertinent risk factors for mortality showed by the final regression model were older age (OR = 1.007, 95% CI: 1.001-1.013, < 0.02), longer hospital length of stay (OR = 1.008, 95% CI: 1.001-1.016, < 0.18), cardiac disease (OR = 3.21, 95% CI: 2.48-4.15, < 0.001), and liver disease (OR = 2.61, 95% CI: 1.73-3.93, < 0.001).

Conclusion: Age, hospital length of stay, and several comorbidities have been shown to be significant risk factors in in-hospital mortality in patients admitted emergently with the primary diagnosis of tracheostomy complications. Each year of age increased the risk of mortality by 0.7% and each additional day in the hospital increased it by 0.8%.
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http://dx.doi.org/10.3390/ijerph19159031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9332357PMC
July 2022

Major Risk Factors for Mortality in Elderly and Non-Elderly Adult Patients Emergently Admitted for Blunt Chest Wall Trauma: Hospital Length of Stay as an Independent Predictor.

Int J Environ Res Public Health 2022 Jul 18;19(14). Epub 2022 Jul 18.

College of Medicine, University of Arizona, Tucson, AZ 85724, USA.

Blunt thoracic trauma is responsible for 35% of trauma-related deaths in the United States and significantly contributes to morbidity and healthcare-related financial strain. The goal of this study was to evaluate factors influencing mortality in patients emergently admitted with the primary diagnosis of blunt chest wall trauma. Adults emergently admitted for blunt chest trauma were assessed using the National Inpatient Sample Database, 2004-2014. Data regarding demographics, comorbidities, and outcomes were collected. Relationships were determined using univariable and multivariable logistic regression models. In total, 1120 adult and 1038 elderly patients emergently admitted with blunt chest trauma were assessed; 46.3% were female, and 53.6% were male. The average ages of adult and elderly patients were 46.6 and 78.9 years, respectively. Elderly and adult patients both displayed mortality rates of 1%. The regression model showed HLOS and several comorbidities as the main risk factors of mortality Every additional day of hospitalization increased the odds of mortality by 9% (OR = 1.09, 95% CI = 1.01-1.18, = 0.033). Mortality and liver disease were significantly associated (OR = 8.36, 95% CI = 2.23-31.37, = 0.002). Respiratory disease and mortality rates demonstrated robust correlations (OR = 7.46, 95% CI = 1.63-34.11, = 0.010). Trauma, burns, and poisons were associated with increased mortality (OR = 3.72, 95% CI = 1.18-11.71, = 0.025). The presence of platelet/white blood cell disease correlated to higher mortality. (OR = 4.42, 95% CI = 1.09-17.91, = 0.038).
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http://dx.doi.org/10.3390/ijerph19148729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9318478PMC
July 2022

Retrospective Review of Trauma ICU Patients With and Without Palliative Care Intervention.

J Am Coll Surg 2022 Aug 8;235(2):278-284. Epub 2022 Apr 8.

Department of Surgery, Division of Trauma and Acute Care Surgery (Dale, Butler, Latifi, Flood), Westchester Medical Center, Valhalla, NY.

Background: Older trauma patients present with poor preinjury functional status and more comorbidities. Advances in care have increased the chance of survival from previously fatal injuries with many left debilitated with chronic critical illness and severe disability. Palliative care (PC) is ideally suited to address the goals of care and symptom management in this critically ill population. A retrospective chart review was done to identify the impact of PC consults on hospital length of stay (LOS), ICU LOS, and surgical decisions.

Study Design: A Level 1 Trauma Center Registry was used to identify adult patients who were provided PC consultation in a selected 3-year time period. These PC patients were matched with non-PC trauma patients on the basis of age, sex, race, Glasgow Coma Scale, and Injury Severity Score. Chi-square tests and Student's t-tests were used to analyze categorical and continuous variables, respectively. Any p value >0.05 was considered statistically significant.

Results: PC patients were less likely to receive a percutaneous endoscopic gastric tube or tracheostomy. PC patients spent less time on ventilator support, spent less time in the ICU, and had a shorter hospital stay. PC consultation was requested 16.48 days into the patient's hospital stay. Approximately 82% of consults were to assist with goals of care.

Conclusion: Specialist PC team involvement in the care of the trauma ICU patients may have a beneficial impact on hospital LOS, ICU LOS, and surgical care rendered. Earlier consultation during hospitalization may lead to higher rates of goal-directed care and improved patient satisfaction.
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http://dx.doi.org/10.1097/XCS.0000000000000220DOI Listing
August 2022

Disparate access to breast cancer screening and treatment.

BMC Womens Health 2022 06 22;22(1):249. Epub 2022 Jun 22.

New York Medical College, Valhalla, NY, 10595, USA.

Background: Barriers to breast cancer screening remain despite Medicaid expansion for preventive screening tests and implementation of patient navigation programs under the Affordable Care Act. Women from underserved communities experience disproportionately low rates of screening mammography. This study compares barriers to breast cancer screening among women at an inner-city safety-net center (City) and those at a suburban county medical center (County). Inner city and suburban county medical centers' initiatives were studied to compare outcomes of breast cancer screening and factors that influence access to care.

Methods: Women 40 years of age or older delinquent in breast cancer screening were offered patient navigation services between October 2014 and September 2019. Four different screening time-to-event intervals were investigated: time from patient navigation acceptance to screening mammography, to diagnostic mammography, to biopsy, and overall screening completion time. Barriers to complete breast cancer screening between the two centers were compared.

Results: Women from lowest income quartiles took significantly longer to complete breast cancer screening when compared to women from higher income quartiles when a barrier was present, regardless of barrier type and center. Transportation was a major barrier to screening mammography completion, while fear was the major barrier to abnormal screening work up.

Conclusion: Disparity in breast cancer screening and management persists despite implementation of a patient navigation program. In the presence of a barrier, women from the lowest income quartiles have prolonged breast cancer screening completion time regardless of center or barrier type. Women who experience fear have longest screening time completion. Future directions aim to increase resource allocation to ameliorate wait times in overburdened safety-net hospitals as well as advanced training for patient navigators to alleviate women's fears.
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http://dx.doi.org/10.1186/s12905-022-01793-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9219222PMC
June 2022

Liver transplantation does not increase morbidity or mortality in women undergoing surgery for breast cancer.

Womens Health (Lond) 2022 Jan-Dec;18:17455057221097554

Department of Surgery, Albany Medical Center, Albany, NY, USA.

Purpose: The incidence of breast cancer following solid organ transplantation is comparable to the age-matched general population. The rate of de novo breast cancer following liver transplantation varies. Furthermore, there is limited information on the management and outcomes of breast cancer in liver transplant recipients. We aim to evaluate the impact of liver transplantation on breast cancer surgery outcomes and compare the outcomes after breast cancer surgery in liver transplant recipient in transplant versus non-transplant centers.

Methods: National Inpatient Sample database was accessed to identify liver transplant recipient with breast cancer. Mortality, complications, hospital charges, and total length of stay were evaluated with multivariate logistic regression testing. Weighted multivariate regression models were employed to compare outcomes at transplant and non-transplant centers.

Results: Ninety-nine women met inclusion criteria for liver transplantation + breast cancer and were compared against women with breast cancer without liver transplantation (n = 736,527). Liver transplantation + breast cancer had lower performance status as confirmed via higher Elixhauser Comorbidity Index (20.5% vs 10.2%, p < 0001). There were significantly more complications in the liver transplantation cohort when compared to the non-liver transplant recipient (15.0% vs 8.2%, p = 0.012). However, on multivariate analysis, liver transplantation was not an independent risk factor for post-operative complications following breast cancer surgery (odd ratio, 1.223, p = 0.480). Cost associated with breast cancer care was significantly higher in those with liver transplantation (2.621, p < 0.001). Breast conservation surgery in liver transplantation had shorter length of stay as compared to breast cancer alone (odds ratio, 0.568, p = 0.027) in all hospitals.

Conclusion: Liver transplantation does not increase short-term mortality when undergoing breast cancer surgery. Although there were significantly more complications in the liver transplantation cohort when compared to the non-liver transplant recipient (15.0% vs 8.2%, p = 0.012), on multivariate analysis, liver transplantation was not an independent risk factor for postoperative complications following breast cancer surgery. Breast cancer management in liver transplant recipient at non-transplant centers incurred higher charges but no difference in complication rate or length of stay when compared to transplant centers.
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http://dx.doi.org/10.1177/17455057221097554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160893PMC
June 2022

Complex Abdominal Wall Reconstruction with Biologic Mesh for Ventral Hernia Repair in Solid Organ Transplant Recipients.

Surg Technol Int 2022 May;40:155-160

Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY.

Background: Ventral hernia is a common occurrence in patients undergoing solid organ transplant (SOT) and who require complex abdominal wall reconstruction (CAWR). The aim of this study was to analyze the outcomes of CAWR in SOT patients in a tertiary center.

Methods: We performed a prospective cohort study in patients who underwent CAWR with biological mesh at our center from January 2016 to November 2021. As per the study protocol, all patients will be followed for 3 years.

Results: During the study period, we performed CAWR in 38 SOT patients. The mean age (Standard Deviation: SD) was 61 (9.5) years and the majority were males (68%). Mean body mass index (SD) was 30.3 (5.5) kg/m2 and hernia repair was performed electively in 33 patients. The majority (82%) of the hernias were less than class 2 with a median mesh size (interquartile range) of 600 (400-800) cm2. Seventy-nine percent of patients were liver transplant recipients and the mesh was placed sub-lay (retro-rectus) (82%); the most common technique was posterior component separation (82%). Five patients (13.2%) had surgical site infection and 4 (10.5%) had unplanned reoperations. None of the patients died postoperatively and the 30-day readmission rate was 21%. Three patients (7.9%) had recurrence during follow-up and all of them underwent reoperation.

Conclusions: Complex abdominal wall reconstruction (CAWR) using biologic mesh for solid organ transplant patients with ventral hernia is safe and has low recurrence when performed by a dedicated CAWR team.
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http://dx.doi.org/10.52198/22.STI.40.HR1573DOI Listing
May 2022

The Risk of Mortality in Geriatric Patients with Emergent Gastroparesis is 7-fold Greater than that in Adult Patients: An Analysis of 27,000 Patients.

Surg Technol Int 2022 May;40:85-95

Minister of Health, Ministry of Health, Republic of Kosova, Prishtina, Kosova.

Background: Gastroparesis, a chronic disorder distinguished by delays in gastric emptying, has been a concern for both health providers and hospitals due to several of its characteristics. Gastroparesis is heterogeneous in nature and is associated with several comorbidities and increasing mortality rates. It can often be caused by underlying conditions, most of which are not well understood. This lack of knowledge regarding its underlying mechanisms creates a need to better understand the risk factors involved in this patient population. This study was undertaken to understand the risk factors involved in the mortality of patients who present with gastroparesis.

Methods: This retrospective study considered data from the National Inpatient Sample for patients who were admitted with a primary diagnosis of gastroparesis from 2005 to 2014. The data were stratified according to various factors of interest to identify risk factors involved in mortality using statistical tools, including a multivariable logistic regression model with backward elimination.

Results: A total of 27,000 patients were admitted emergently with a primary diagnosis of gastroparesis. The mortality rate in adult patients (0.18%, N=39) was much lower than that in elderly patients (1.27%, N=71). Females accounted for the majority of patients in both the adult (73.7%) and elderly (71%) populations. The mean age of patients in the adult and elderly groups was 43 and 75 years, respectively. The association between mortality and age was significant in both adults (OR=1.04, 95%CI=1.005-1.08, p<0.025) and the elderly (OR=1.08, 95%CI=1.04-1.12, p<0.001). The hospital length of stay (HLOS, days) in adult females (5.08, SD=5.04) was significantly longer than that in adult males (4.41, SD=5.10) (p<0.001). The association between mortality and HLOS was significant in both adults (OR=1.12, 95%CI=1.09-1.15, p<0.001) and elderly patients (OR=1.10, 95%CI=1.06-1.14, p<0.001). A lower percentage of adults (6.6%, N=1,402) underwent an operation compared to the elderly (9.6%, N=538). The mean time to operation was 4.76 days for adult patients who survived and 17.50 days for adult patients who did not survive (SD=5.37 and 9.37, respectively, p=0.006). On the other hand, this value was 5.57 and 9.10 days for elderly patients (SD=6.50 and 7.15, respectively, p=0.037). Among patients who underwent an operation, the association between mortality and time to operation was significant for both adults (OR=1.17, 95%CI=1.094-1.247, p<0.001) and elderly patients (OR=1.05, 95%CI=1.005-1.124, p<0.001).

Conclusion: The risk of mortality in elderly patients with emergent gastroparesis was 7-fold greater than that in adult patients. The odds of mortality increased by 8% for every year increase in age in elderly patients and by 4% in adults.
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http://dx.doi.org/10.52198/22.STI.40.GS1566DOI Listing
May 2022

Surgery for Complex Abdominal Wall Defects: Update of a Nine-Step Treatment Strategy.

Surg Technol Int 2022 03 10;40. Epub 2022 Mar 10.

Department of Surgery, Westchester Medical Center Health, Valhalla, NY, USA.

Complex abdominal wall defects (CAWDs) are a new surgical entity that require a dedicated and multidisciplinary approach. The spectra of CAWDs and complex abdominal wall reconstruction (CAWR) are poorly defined, and may include any of these elements: large or multiple recurrent hernia, presence of previously placed mesh (open or laparoscopic), loss of abdominal wall domain due to trauma, infection or tumor resection, hernia in the presence of enterocutaneous or enteroatmospheric fistulae (ECF/EAF), hernia in the presence of infected sinus tract, large debilitating parastomal hernia, hernias in the presence of synthetic erosion into the bowel or causing intestinal obstruction, eroded hernias post open abdomen management with skin graft in the presence of intraabdominal catastrophe or massive trauma, and hernias (umbilical or ventral/incisional) in patients with cirrhosis in the presence of massive ascites. The relevance of abdominal wall reconstruction with reinforcement using synthetic or biological mesh has never been as high as it is now. In particular, the use of biological mesh is rising exponentially due to its inherent properties. We previously described a nine-step approach to the management of difficult abdomen with enterocutaneous fistula. In this paper, we update this strategy based on our recent experience with almost 300 patients at our institution who underwent CAWR. Special attention is paid to the management of contaminated fields and the rationale of using biological mesh.
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http://dx.doi.org/10.52198/22.STI.40.HR1557DOI Listing
March 2022

Serial rotational thromboelastography (ROTEM) in mechanically ventilated patients with COVID-19 demonstrates hypercoagulopathy despite therapeutic heparinization.

Trauma Surg Acute Care Open 2022 10;7(1):e000603. Epub 2022 Mar 10.

Department of Surgery, Westchester Medical Center, Valhalla, New York, USA.

Background: Clinical hypercoagulopathy in patients with COVID-19 has been anecdotally described, but there is lack of evidence due to the novelty of this disease. Our study reports the results of rotational thromboelastography (ROTEM) in relation to traditional laboratory coagulation tests and acute phase markers among a cohort of severely ill, mechanically ventilated patients with COVID-19.

Methods: Patients with COVID-19 (N=21) with respiratory failure requiring mechanical ventilation were included in this prospective case series. ROTEM was serially obtained for all patients on three different days during their intensive care unit (ICU) stay and analyzed using repeated measures analysis. Demographic variables, symptoms at the time of presentation, ROTEM values, laboratory values for traditionally measured coagulation profiles, and acute phase reactants were analyzed, in addition to the use of anticoagulation and clinical hypercoagulopathic complications.

Results: The average age of our cohort was 57.9 years old (SD=14.4) and 76.2% were male. The mortality rate was 14.3% (3 of 21). Two patients (12.5%) were identified to have new-onset deep vein thrombosis, two patients (12.5%) were found to have ≥3 episodes of central venous catheter thrombosis, and three patients (18.7%) had confirmed stroke. ROTEM demonstrated elevated EXTEM and INTEM clotting times, including elevated FIBTEM maximum clot firmness (MCF). All patients treated with therapeutic anticoagulation still demonstrated hypercoagulopathy within the MCF tests.

Discussion: Repeated measure ROTEMs were able to detect hypercoagulopathy in ICU patients with COVID-19 despite therapeutic anticoagulation with heparin.

Level Of Evidence: III.
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http://dx.doi.org/10.1136/tsaco-2020-000603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8914399PMC
March 2022

WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment.

World J Emerg Surg 2022 03 4;17(1):13. Epub 2022 Mar 4.

John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.

The aim of this paper was to review the recent literature to create recommendations for the day-to-day diagnosis and surgical management of small bowel and colon injuries. Where knowledge gaps were identified, expert consensus was pursued during the 8th International Congress of the World Society of Emergency Surgery Annual (September 2021, Edinburgh). This process also aimed to guide future research.
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http://dx.doi.org/10.1186/s13017-022-00418-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8896237PMC
March 2022

Risk factors and predictors of violence: insights from the emergency department at a level 1 trauma center in the USA.

J Public Health (Oxf) 2022 Feb 15. Epub 2022 Feb 15.

Department of Surgery, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA.

Background: This study aimed to assess the risk factors and predictors of violence among patients admitted to a Level 1 trauma center in a single institution.

Methods: We conducted a retrospective analysis of patients who were admitted with a history of violence between 2012 and 2016.

Results: A total of 9855 trauma patients were admitted, of whom 746 (7.6%) had a history of violence prior to the index admission. Patients who had history of violence were younger and more likely to be males, Black, Hispanic and covered by low-income primary payer in comparison to non-assault trauma patients (P < 0.001 for all). Multivariate logistic regression analysis showed that covariate-adjusted predictors of violence were being Black, male having low-income primary payer, Asian, drug user, alcohol intoxicated and smoker.

Conclusions: Violence is a major problem among young age subjects with certain demographic, social and ethnic characteristics. Trauma centers should establish violence injury prevention programs for youth and diverse communities.
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http://dx.doi.org/10.1093/pubmed/fdac010DOI Listing
February 2022

Firearms: the leading cause of years of potential life lost.

Trauma Surg Acute Care Open 2022 4;7(1):e000766. Epub 2022 Feb 4.

Surgery, Westchester Medical Center, Valhalla, New York, USA.

Objectives: Data from the Centers for Disease Control and Prevention (CDC) show that firearm deaths are increasing in the USA. The aims of this study were to determine the magnitude of potential years of life lost due to firearms and to examine the evolution of firearm deaths on the basis of sex, race, and geographical location within the USA.

Methods: Data was extracted (2009-2018) from the National Vital Statistics Reports from the CDC and the Web-based Injury Statistics Query and Reporting System database. Years of potential life lost was calculated by the CDC standard of subtracting the age at death from the standard year of 80, and then summing the individual years of potential life lost (YPLL) across each cause of death.

Results: The YPLL in 2017 and 2018 was higher for firearms than motor vehicle crashes (MVCs). In 2018, the YPLL for firearms was 1.42 million and 1.34 million for MVC. Males comprised the majority (85.4%) of the 38 929 firearm deaths. White males had the most YPLL due to suicide, with 4.95 million YPLL during the course of the 10-year period; black males had the most YPLL due to homicide with 3.2 million YPLL during the same time period. The largest number of suicides by firearms was in older white males. Firearm-related injury deaths were highest in the South, followed by the West, Midwest, and Northeast, respectively.

Conclusion: Firearms are now the leading cause of YPLL in trauma. Firearm deaths have overtaken MVC as the mechanism for the main cause of potential years of life lost since 2017. Suicide in white males accounts for more YPLL than homicides. Deaths related to firearms are potentially preventable causes of death and prevention efforts should be redirected.

Level Of Evidence: Level III-Descriptive Study.
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http://dx.doi.org/10.1136/tsaco-2021-000766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819782PMC
February 2022

Do the benefits of prophylactic inferior vena cava filters outweigh the risks in trauma patients? A meta-analysis.

Acta Chir Belg 2022 Jun 27;122(3):151-159. Epub 2022 Jan 27.

Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.

Introduction: The aim of this systematic review and meta-analysis was to evaluate whether the benefits of prophylactic inferior vena cava filters (IVCF) outweigh the risks thereof.

Patients And Methods: PubMed, EMBASE, and Cochrane Library were systematically searched for records published from 1980 to 2018 by two independent researchers (MG, GG). The endpoints of interest were pulmonary embolism (PE) and deep vein thrombosis (DVT) rates. Quality assessment, data extraction and analysis were performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Mantel-Haenszel method with odds ratio and 95% confidence interval (OR (95%CI)) as the measure of effect size was utilized for meta-analysis.

Results: Fifteen studies (two randomized controlled trials and 13 observational studies) were included in the meta-analysis. PE rate was 0.9% (11/1183) in IVCF vs. 0.6% (240/39,417) in No IVCF. This difference was not statistically significant [OR (95%CI) = 0.31 (0.06, 1.51);  = 0.15]. DVT rate was 8.4% (77/915) in IVCF vs. 1.7% (653/38,807) in No IVCF. The difference was not statistically significant [OR (95%CI) = 2.67 (0.90, 7.98);  = 0.08]. In the subset of RCTs, PE rate was 0% (0/64) in IVCF vs. 12% (6/5) in No IVCF. This difference was statistically significant [OR (95%CI) = 0.12 (0.01, 1.03);  = 0.05].

Conclusions: This meta-analysis found that prophylactic IVCF may be associated with decreased PE rates at the possible cost of increased DVT rates. Further observational and experimental clinical studies are needed to confirm the findings of this meta-analysis.
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http://dx.doi.org/10.1080/00015458.2022.2031534DOI Listing
June 2022

Risk Factors of Mortality in Patients Hospitalized With Chronic Duodenal Ulcers.

Am Surg 2022 Apr 3;88(4):764-769. Epub 2022 Jan 3.

Department of Surgery, 8138Westchester Medical Center, Valhalla, NY, USA.

Background: We aimed to identify risk factors of mortality in patients hospitalized with duodenal ulcers (DUs).

Methods: A National Inpatient Sample-based retrospective cohort study from 2005 to 2014 was conducted on patients undergoing emergency admission for chronic DUs. Demographics, clinical data, and outcomes were collected. Multivariable logistic regression model was applied to find the risk factors of mortality.

Results: 70 641 patients were included in this study, of which 30 525 (43%) were non-elderly (< 65 years) and 40 116 (57%) were elderly (65+ years) patients. 72% of non-elderly and 57% of elderly patients were males. Mortality rate of men vs women was similar in non-elderly group (1.9% vs 2%, respectively), whereas it significantly differed in elderly patients (4.5% vs 5.3%, respectively, P<.0001). Time to operation was 1.15 (1.83) days in survived vs 1.55 (3.86) days in deceased non-elderly patients ( < .001). Time to operation was .85 (1.73) days in survived vs 1.79 (7.28) days in deceased elderly patients ( < .001). In patients with operation, age, delayed operation, frailty, and presence of perforation were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was shown as a protective factor in elderly patients. In the final model for patients with no operation, age, hospital length of stay, and frailty were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was revealed as a protective factor in all patients as well.

Conclusion: Early operation in patients with DU requiring surgical intervention is essential to improve the outcomes.
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http://dx.doi.org/10.1177/00031348211054074DOI Listing
April 2022

Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids.

Am Surg 2022 May 3;88(5):936-942. Epub 2022 Jan 3.

Department of Surgery, School of Medicine, 8138Westchester Medical Center and New York Medical College, Valhalla, NY, USA.

Background: The study explored determinants of mortality of admitted emergently patients with the primary diagnosis of hemorrhoids, during the years 2005-2014.

Methods: Demographics, clinical data, and outcomes were obtained from the National Inpatient Sample, 2005-2014, in elderly (65+ years) and non-elderly adult patients (18-64 years) with hemorrhoids who underwent emergency admission. Multivariable logistic regression model with backward elimination was used to identify predictors of mortality.

Results: 25 808 adult and 26 978 elderly patients were included. Female patients consisted of 42.5% and 59.3% in adult and elderly, respectively. 42 (.2%) adults died, of which 50% were female and 125 (.5%) elderly patients died, of which 60% were female. Mean (SD) age of the adult patients was 47.8 (11) years and in elderly patients was 78.7 (8) years. 82.2% and 85.7% had internal hemorrhoids in adult and elderly patients, respectively. 9326 (36.1%) adult and 7282 (27%) elderly patients underwent an operation. In the final multivariable logistic regression model for adult patients with operation, delayed operation and invasive diagnostic procedures increased the odds of mortality, whereas in elderly patients, delayed operation and frailty index were the risk factors of mortality. In both adults and elderly with no operation, increased hospital length of stay (HLOS) significantly increased the odds of mortality, and undergoing an invasive diagnostic procedure significantly decreased the odds of mortality.

Conclusion: In all operated patients, increased time to operation and undergoing an invasive diagnostic procedure were the risk factors for mortality. On the other hand, in non-operated emergency hemorrhoids patients, increased age and increased HLOS were the risk factors for mortality while undergoing an invasive diagnostic procedure decreased the odds of mortality.
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http://dx.doi.org/10.1177/00031348211060420DOI Listing
May 2022

Delayed Operation as a Major Risk Factor for Mortality Among Elderly Patients with Ventral Hernia Admitted Emergently: An Analysis of 33,700 Elderly Patients.

Surg Technol Int 2021 11;39:206-213

Westchester Medical Center Health Network, New York Medical College, School of Medicine and Westchester Medical Center, Valhalla, NY.

Background: Elderly patients admitted emergently for ventral hernia may have high rates of complications, including morbidity and mortality. The goal of this study was to retrospectively assess risk factors for in-hospital mortality for elderly patients admitted emergently with a primary diagnosis of ventral hernia.

Methods: Elderly patients with ventral hernia that required emergency admission were analyzed using the National Inpatient Sample database, 2005-2014. Demographics, clinical data, and outcomes were collected. The relationship between mortality and the predictors was assessed using a stratified analysis, multivariable logistic regression model, and multivariable generalized additive model.

Results: A total of 33,700 elderly patients were analyzed. The mean (SD) age for males and females was 75 (7.25) and 76.25 (7.75) years, respectively (p<0.001). Approximately 70% of the patients were females. The mean (SD) hospital length of stay (HLOS) was 6.3 (6.5) and 11.6 (13.7) days in survived vs. deceased patients (p<0.001), respectively. Gangrene was present in 1.5% of survivors vs. 5.6% of deceased (p<0.001) patients. Intestinal obstruction was observed in 78% of survivors vs. 88% of deceased patients (p<0.001). Of the 8,554 cases managed non-operatively, 2.1% died. In contrast, in the 25,163 patients who were operated upon, the mortality rate was 2.9%. The mean (SD) HLOS was 7.39 (7.41) days in patients who had an operation vs. 3.82 (3.48) days in those who did not (p<0.0001). Time to operation was 1.12 (1.97) days in survivors vs. 1.81 (3.02) days in deceased patients (p<0.001). In the final multivariable logistic regression model for patients who underwent an operation, delayed operation, elderly male, frailty, invasive diagnostic procedures and presence of gangrene or obstruction were the main risk factors for mortality. In the final model for patients who did not have an operation, age, frailty, presence of gangrene or obstruction and HLOS were the main risk factors for mortality.

Conclusion: A delayed operation in elderly males and frail patients with intestinal obstruction or gangrene admitted emergently due to ventral hernia significantly increases mortality in this setting.
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http://dx.doi.org/10.52198/21.STI.39.HR1520DOI Listing
November 2021

Ventral Hernia Should be Treated Surgically and No One Should Die From It.

Authors:
Rifat Latifi

Surg Technol Int 2021 11;39:204-205

New York Medical College, School of Medicine, Department of Surgery, Westchester Medical Center Health, Valhalla, New York.

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November 2021

Outcomes of Emergency Gastrointestinal Surgery Done on Post-Cardiac Surgery Patients-Analysis From a Tertiary Care Center.

Surg Technol Int 2021 11;39:120-125

New York Medical College, School of Medicine, Department of Surgery, Chief Section of General Surgery, Westchester Medical, Center Health, Valhalla, New York.

Introduction: Abdominal complications following cardiac surgery have high mortality rates. This study analyzes the outcomes of patients who have undergone emergency general surgery (EGS) procedures after cardiothoracic surgery (CTS) at the same hospitalization.

Materials And Methods: This was a retrospective analysis of all patients who underwent emergent abdominal surgery after CTS surgery between 2010-2018. The CTS procedures included coronary artery bypass graft (CABG), valve replacement, cardiac transplant, aortic replacement, ventricular assist device, and pericardial procedures. The records were reviewed to obtain demographics, frequency distribution of EGS procedures, complications, outcomes, and the risk factors of mortality.

Results: Of 4826 patients who had CTS, 57 (1.2%) underwent EGS procedures during the period of 2010-2018. This cohort of patients had 113 CTS and 85 EGS procedures during the same hospitalization. The mean age was 62 years, and 49% were elderly (40% were females). CABG with or without valve replacement was the most common surgery (28%). After surgical consultation for "acute abdomen" in the post-CTS phase, the three most common findings on exploratory laparotomy were bowel perforation (23%), massive free fluid leading to abdominal compartment syndrome (19%), and acute cholecystitis (16%). Respiratory failure (46%), acute kidney injury (32%), and multiple organ dysfunction (18%) were the most common hospital-acquired complications. Regarding dispositions, 47% were discharged to an acute rehabilitation center, 10% were discharged to a sub-acute rehabilitation center, and a similar proportion of patients went home (10%). On multivariable logistic regression analysis with backward elimination, age (OR=1.10, 95% CI: 1.02-1.18) and serum proteins (OR=0.99, 95% CI: 0.98-0.998) were independently associated with the odds of mortality after EGS in the immediate CTS phase.

Conclusions: Respiratory failure is the most common complication of EGS immediately after CTS. The older the patient and the lower the serum proteins, the higher the odds of mortality in patients who undergo EGS after ETS.
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November 2021

The Role of Telemedicine in Surgical Specialties During the COVID-19 Pandemic: A Scoping Review.

World J Surg 2022 01 6;46(1):10-18. Epub 2021 Nov 6.

Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA.

Background: The objective of this study was to evaluate the current body of evidence on the use of telemedicine in surgical subspecialties during the COVID-19 pandemic.

Methods: This was a scoping review conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). MEDLINE via Ovid, PubMed, and EMBASE were systematically searched for any reports discussing telemedicine use in surgery and surgical specialties during the first period (February 2020-August 8, 2020) and second 6-month period (August 9-March 4, 2021) of the COVID-19 pandemic.

Results: Of 466 articles screened through full text, 277 articles were included for possible qualitative and/or quantitative data synthesis. The majority of publications in the first 6 months were in orthopedic surgery, followed by general surgery and neurosurgery, whereas in the second 6 months of COVID-19 pandemic, urology and neurosurgery were the most productive, followed by transplant and plastic surgery. Most publications in the first 6 months were opinion papers (80%), which decreased to 33% in the second 6 months. The role of telemedicine in different aspects of surgical care and surgical education was summarized stratifying by specialty.

Conclusion: Telemedicine has increased access to care of surgical patients during the COVID-19 pandemic, but whether this practice will continue post-pandemic remains unknown.
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http://dx.doi.org/10.1007/s00268-021-06348-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572066PMC
January 2022

Risk Factors for Mortality in Patients with Ventral Hernia Admitted Emergently: An Analysis of 48,539 Adult Patients.

Surg Technol Int 2021 11;39:183-190

Westchester Medical Center, Valhalla, NY.

Background: More than 400,000 cases of ventral hernia (VH) are repaired each year in the U.S. This condition is a major problem with significant morbidly and mortality. The aim of this study was to evaluate independent predictors of in-hospital mortality for patients with a primary diagnosis of VH who were admitted emergently.

Methods: Non-elderly adults (age 18-64 years) with ventral hernias that required emergency admission were analyzed using the National Inpatient Sample database, 2005-2014. Demographics, clinical data, and outcomes were collected. The relationships between mortality and predictors were assessed using a multivariable logistic regression model.

Results: Overall, 48,539 patients were identified. The mean (SD) age for both males and females was 50 (9.6). Overall mortality was low (316 or 0.7%). Males accounted for 35% of the total sample and 45% of all mortalities (p <0.001). The mean (SD) hospital length of stay (HLOS) was 4.9 (6.3) and 12.3 (20.6) days in surviving and deceased patients (p <0.001), respectively. Approximately 1.1% of surviving and 6% of deceased patients had gangrene (p <0.001). Intestinal obstruction was observed in 70% of surviving and 83% of deceased patients (p <0.001). While a vast majority of the patients (40,602) were operated on, 8,023 patients were not; 0.7% and 0.4% died, respectively. The mean (SD) HLOS was 5.30 (6.99) days in patients who underwent an operation and 2.97 (2.96) days in those who did not (P <0.0001). Time to operation was 0.81 (1.92) days in surviving and 1.34 (2.42) days in deceased patients (p <0.001). In the final multivariable regression model for patients who underwent an operation, age, male sex, presence of gangrene or obstruction, and longer time to operation were the main risk factors for mortality. For patients who did not undergo an operation, only HLOS and presence of obstruction were the main risk factors for mortality.

Conclusion: Male sex, presence of gangrene or obstruction at the presentation, and delayed operation were shown to be risk factors for mortality in adult patients with ventral hernia admitted emergently.
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November 2021

Does Endovascular Repair for Blunt Traumatic Aortic Injuries Provide Better Outcomes Compared to Its Open Technique? A Systematic Review and Meta-analysis.

Surg Technol Int 2021 11;39:283-296

Westchester Medical Center, Valhalla, NY.

Introduction: Traumatic aortic injuries are devastating events in terms of high mortality and morbidity in most survivors. We aimed to compare the outcomes of endovascular repair (ER) vs. open repair (OR) in the treatment of traumatic aortic injuries.

Methods: PubMed, Embase, and Cochrane Library were systematically searched. Postoperative mortality was the primary endpoint. Secondary endpoints included intensive care unit (ICU) length of stay, hospital length of stay, operating time, paraplegia, stroke, acute renal failure, and reoperation rate. The Mantel-Haenszel method (random-effects model) with odds ratios and 95% confidence intervals (OR (95% CI)), and the inverse variance method with the mean difference (MD (95% CI)), were used to measure the effects of continuous and categorical variables, respectively.

Results: A total of 49 studies involving 12,857 patients were included. Postoperative mortality was not significantly different between the two groups (p=0.459). Among secondary outcomes, the paraplegia rate was significantly lower after ER (p=0.032). Other secondary endpoints such as ICU length of stay (p=0.329), hospital length of stay (p=0.192), operating time (p=0.973), stroke rate (p=0.121), ARF rate (p=0.928), and reoperation rate (p=0.643) did not significantly differ between the two groups.

Conclusion: This meta-analysis found that ER was associated with a reduced paraplegia rate compared to OR for the management of traumatic aortic injury.
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November 2021

Robotic Inguinal Hernias Performed at a Community Hospital: a Case Series of 292 Patients.

Surg Technol Int 2021 10;39:197-203

Department of Surgery, Westchester Medical Center, Valhalla, NY.

Background: Robotic inguinal hernia repair has become more common and has replaced the laparoscopic approach in many hospitals in the US. We present a retrospective review of 416 consecutive inguinal hernia repairs using the robotic transabdominal preperitoneal approach in an academic community hospital.

Methods: This is a retrospective review of 416 consecutive robotic inguinal hernia repairs in 292 patients performed from October 2015 to March 2021 by two surgeons. The demographics, intra-operative findings, and postoperative outcomes were analyzed. The results for patients during the initial 25 cases (which were considered to be during the learning curve for each surgeon) were compared to their subsequent cases. A multivariable logistic regression analysis was used to determine independent risk factors for postoperative complications.

Results: Overall, 292 patients underwent 416 inguinal hernia repairs, of whom 124 (42.5%) had bilateral hernias. The mean age was 61 years and the mean BMI was 26.96 kg/m2. Of the bilateral hernias, 31.5% were unsuspected pre-operatively. Femoral hernias were found in 20.5% of patients, including in 18.4% of men, which were also unsuspected. Post-operatively, 89% of patients were discharged home the same day. The most common post-operative complication was seroma, which occurred in 13%. Three patients required re-intervention: one had deep SSI (infected mesh removal), one had a needle aspiration of a hematoma (SSORI), and one was operated on for small bowel volvulus related to adhesions. On short-term follow-up, there was only one early recurrence (0.2%). When cases during the learning curve period were compared to subsequent surgeries, there were no major differences in post-operative complications or operating time. Patients aged ≥55 years had a 2.456-fold (p=0.023) increased odds of post-operative complications.

Conclusions: Robotic inguinal hernia repair can be safely performed at a community hospital with few early post-operative complications and very low early recurrence rates. The robotic approach also allows for the detection of a significant number of unsuspected contralateral inguinal hernias and femoral hernias, especially in male patients. Age ≥55 years was an independent risk factor for postoperative complications.
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October 2021

Pelvic fractures in severely injured elderly: a double-adjustment propensity score matched analysis from a level I trauma center.

Eur J Trauma Emerg Surg 2022 Jun 25;48(3):2219-2228. Epub 2021 Aug 25.

Clinical Research Unit, Westchester Medical Center, 100 Woods Road, Taylor Pavilion, Office E-348, Valhalla, NY, 10595, USA.

Purpose: Pelvic trauma has increased risk of mortality in the elderly. Our study aimed to analyze the impact of the additional burden of pelvic fractures in severely injured elderly.

Methods: This is a retrospective analysis of a prospectively maintained trauma registry from 2012 to 2018 at an American College of Surgeons (ACS) verified Level I Trauma Center. Trauma patients aged ≥ 65 years with ISS ≥ 16 and AIS severity score ≥ 3 in at least two body regions were divided in two groups: group I, consisted of elderly polytrauma patients without pelvic fractures, and group II elderly who had concomitant pelvic fractures. We used a double-adjustment method using propensity score matching (PSM) with subsequent covariate adjustment to minimize the effect of confounding factors, and give unbiased estimation of the impact of pelvic fractures. Balance assessment was conducted by computing absolute standardized mean differences (ASMDs) and ASMD < 0.10 reflects good balance between groups.

Results: Of 12,774 patients admitted during this time, 411 (3.2%) elderly with a mean age of 77.75 ± 8.32 years met the inclusion criteria. Of this cohort, only 92 patients (22.4%) had pelvic fractures. Females outnumbered males (55 vs. 45%). Comparing characteristics of group I and group II using ASMDs, pelvic trauma patients were more likely to have higher systolic blood pressure (SBP), head injuries, lower extremity injuries, anticoagulant therapy, and cirrhosis. Fewer variables differed significantly after matching. We observed few instances of worse outcomes associated with pelvic trauma using PSM with and without covariate adjustment. Crude PSM without covariate adjustment, showed a significantly higher rate of deep vein thrombosis (DVT) for pelvic trauma (p < 0.001). Crude PSM also showed a significantly higher rate of ventilator-associated pneumonia (VAP) in group II (p = 0.006). PSM with covariate adjustment did not confirm differences on these outcomes. PSM both without and with covariate adjustment found lower ventilator days and ICU length of stay among patients with pelvic trauma. No significant differences were seen on 12 outcomes: death, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), cardiac arrest with cardiopulmonary resuscitation (CPR), myocardial infarction (MI), pulmonary embolism (PE), unplanned intubation, unplanned admission to intensive care unit (ICU), catheter-associated urinary tract infection (CAUTI), and hospital length of stay.

Conclusions: At a Level I Trauma Center the additional burden of pelvic fractures in seriously injured elderly did not translate into higher mortality. PSM without covariate adjustment suggests worse rates among pelvic trauma patients for DVT and VAP but covariate adjustment removed statistical significance for both outcomes. Pelvic trauma patients had shorter time on ventilator and in the ICU. Whether similar analytic methods applied to patients from larger data sources would produce similar findings remains to be seen.
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http://dx.doi.org/10.1007/s00068-021-01772-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8385478PMC
June 2022

Invited commentary: A prospective randomized trial on parents' disease knowledge and quality of life. Shall WeChat about telehealth?

J Card Surg 2021 Oct 2;36(10):3698-3701. Epub 2021 Aug 2.

Department of Surgery, New York Medical College, School of Medicine, West Chester Medical Center, Valhalla, New York, USA.

WeChat and access to wireless communication may offer a continuum of care following medical and surgical intervention. This cardiac surgery research study evaluates the process of parental education and social support following pediatric cardiac surgery utilizing standard of care compared to telehealth.
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http://dx.doi.org/10.1111/jocs.15851DOI Listing
October 2021

Complex abdominal wall reconstruction for management of umbilical hernia in cirrhotic patients with ascites: A video technique demonstration.

Cir Esp (Engl Ed) 2021 Jun-Jul;99(6):463

Department of Surgery, New York Medical College, School of Medicine, Valhalla, NY, United States; Department of Surgery, Westchester Medical Center Health, Valhalla, NY, United States. Electronic address:

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http://dx.doi.org/10.1016/j.cireng.2020.11.017DOI Listing
February 2022

Pushing the Surgical Envelope.

Authors:
Rifat Latifi

World J Surg 2021 Dec 20;45(12):3482-3483. Epub 2021 May 20.

Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.

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http://dx.doi.org/10.1007/s00268-021-06166-5DOI Listing
December 2021

Safety analysis of a multispecialty surgical volunteerism mission over thirteen years - age alone is not a contradiction.

Acta Chir Belg 2021 Apr 29:1-20. Epub 2021 Apr 29.

Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY.

Introduction: About five billion people worldwide lack access to safe surgery and multispecialty surgical volunteer missions (SVMs) offer a plausible solution to this problem. This study aimed to evaluate the outcomes of elderly patients operated on over 13 surgical missions between 2006 and 2019 from "Operation Giving Back Bohol" Tagbilaran, Philippines.

Patients And Methods: This was a retrospective analysis of prospectively collected data on all patients treated during SVM over 13 years (2006-2019). Non-elderly (age 16-64 years) were compared with the elderly (age ≥65 years) for pre-, intra-, and postoperative variables. Multivariable logistic regression was utilized to identify independent predictors of postoperative complications.

Results: Of 1184 patients, the majority (1030) were in the non-elderly group and 154 in the elderly. The mean age was 36 ± 13.6 and 68.3 ± 3.8 years in the non-elderly and elderly groups, respectively. Comorbidities, type of surgery, type of anesthesia, operating time, estimated blood loss, estimated blood loss, need for blood transfusion, postoperative complication rates, comprehensive complication index, length of hospital, ICU requirement, and mortality rates stay did not significantly differ between the groups. Multivariable logistic regression found pelvic surgery (OR (95%CI) = 3.7 (1.3-10.8);  = 0.01), hypertension (OR (95%CI) = 8.4 (2.2-32.9);  < 0.01), and intraoperative blood loss (OR (95%CI) = 1.007 (1.005-1.009);  < 0.01) to be independent predictors of postoperative complications.

Conclusions: Elderly patients may be safely undergo general surgery procedures in surgical volunteer missions, and age alone should not preclude them.
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April 2021

Successful Management of COVID-19 Infection in 2 Early Post-Liver Transplant Recipients.

Transplant Proc 2021 May 19;53(4):1175-1179. Epub 2021 Mar 19.

Transplant Surgery, Westchester Medical Center, Valhalla, New York.

Background: Coronavirus disease 2019 (COVID-19) has affected all facets of life and continues to cripple nations. COVID-19 has taken the lives of more than 2.1 million people worldwide, with a global mortality rate of 2.2%. Current COVID-19 treatment options include supportive respiratory care, parenteral corticosteroids, and remdesivir. Although COVID-19 is associated with increased risk of morbidity and mortality in patients with comorbidities, the vulnerability, clinical course, optimal management, and prognosis of COVID-19 infection in patients with organ transplants has not been well described in the literature. The treatment of COVID-19 differs based on the organ(s) transplanted. Preliminary data suggested that liver transplant patients with COVID-19 did not have higher mortality rates than untransplanted COVID-19 patients. Table 1 depicts a compiled list of current published data on COVID-19 liver transplant patients. Most of these studies included both recent and old liver transplant patients. No distinction was made for early liver transplant patients who contract COVID-19 within their posttransplant hospitalization course. This potential differentiation needs to be further explored. Here, we report 2 patients who underwent liver transplantation who acquired COVID-19 during their posttransplant recovery period in the hospital.

Case Descriptions: Two patients who underwent liver transplant and contracted COVID-19 in the early posttransplant period and were treated with hydroxychloroquine, methylprednisolone, tocilizumab, and convalescent plasma. This article includes a description of their hospital course, including treatment and recovery.

Conclusion: The management of post-liver transplant patients with COVID-19 infection is complicated. Strict exposure precaution practice after organ transplantation is highly recommended. Widespread vaccination will help with prevention, but there will continue to be patients who contract COVID-19. Therefore, continued research into appropriate treatments is still relevant and critical. A temporary dose reduction of immunosuppression and continued administration of low-dose methylprednisolone, remdesivir, monoclonal antibodies, and convalescent plasma might be helpful in the management and recovery of severe COVID-19 pneumonia in post-liver transplant patients. Future studies and experiences from posttransplant patients are warranted to better delineate the clinical features and optimal management of COVID-19 infection in liver transplant recipients.
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http://dx.doi.org/10.1016/j.transproceed.2021.03.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972672PMC
May 2021
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