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Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis.

Ann Coloproctol 2021 Jun 24. Epub 2021 Jun 24.

Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Purpose: The objective of this study was to compare the perioperative outcomes between single-incision laparoscopic appendectomy (SILA) and 3-port conventional laparoscopic appendectomy (CLA) in enhanced recovery after surgery (ERAS) protocol.

Methods: Of 101 laparoscopic appendectomy with ERAS protocol cases for appendicitis from March 2019 to April 2020, 54 patients underwent SILA with multimodal analgesic approach (group 1) while 47 patients received CLA with multimodal analgesic approach (group 2). SILA and CLA were compared with the single institution's ERAS protocol. Read More

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Analytic Morphomics Are Related to Outcomes After Lung Volume Reduction Surgery.

Semin Thorac Cardiovasc Surg 2021 Jun 21. Epub 2021 Jun 21.

Division of Acute Care Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.

Lung volume reduction surgery continues to have a high morbidity despite National Emphysema Treatment Trial selection criteria. This study evaluated the association between analytic morphomics on chest computed tomography scans and outcomes after lung volume reduction surgery. In a retrospective review of 85 lung volume reduction surgery patients from 1998-2013, dorsal muscle group area, subcutaneous and visceral fat area, and bone mineral density were assessed using analytic morphomics. Read More

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Employing a Xiphoid-umbilicus Approach in an Endoscopic Totally Extraperitoneal Procedure for the Preperitoneal Repair of Midline Ventral Hernias.

Surg Laparosc Endosc Percutan Tech 2021 Jun 23. Epub 2021 Jun 23.

Department of Hernia and Abdominal Wall Surgery, East Hospital Affiliated to Tongji University Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Department of General Surgery, Northeast International Hospital, Shenyang, Liaoning Province Department of Gastrointestinal Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang Province, China.

Objectives: Endoscopic totally extraperitoneal sublay (TES) repair seems to be a promising procedure for treating ventral hernias because repairing at the preperitoneal layer reduces damage to the natural musculoaponeurotic structures of the abdominal wall. This article reports the preliminary surgical results after such a procedure with a xiphoid-umbilicus approach for a midline ventral hernia of the middle-upper abdomen.

Materials And Methods: Fifteen cases with a small midline ventral hernia scheduled for preperitoneal repair with a TES procedure with a xiphoid-umbilicus approach were included. Read More

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Simultaneous Use of Hypertonic Saline and IV Furosemide for Fluid Overload: A Systematic Review and Meta-Analysis.

Crit Care Med 2021 Jun 24. Epub 2021 Jun 24.

Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN. Division of Intensive Care Unit, Department of Critical Care Medicine, the First Affiliated Hospital of UTSC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. Mayo Clinic Library, Evidence-based Practice Center, Mayo Clinic, Rochester, MN. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN. Unidad de Conocimiento y Evidencia, CONEVID, Universidad Peruana Cayetano Heredia, Lima, Peru. Division of Critical Care, Department of Medicine, Mayo Clinic Health System, Mankato, MN.

Objectives: To evaluate the efficacy of the simultaneous hypertonic saline solution and IV furosemide (HSS+Fx) for patients with fluid overload compared with IV furosemide alone (Fx).

Data Sources: Electronic databases (MEDLINE, EMBASE, CENTRAL, Cochrane Database of Systematic Reviews, PsycINFO, Scopus, and WOS) were searched from inception to March 2020.

Study Selection: Randomized controlled trials on the use of HSS+Fx in adult patients with fluid overload versus Fx were included. Read More

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Long-Term Functional Outcome and Quality of Life Following In-Hospital Cardiac Arrest-A Longitudinal Cohort Study.

Crit Care Med 2021 Jun 24. Epub 2021 Jun 24.

Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Department of Physiotherapy, St. Vincent's Hospital, Melbourne, VIC, Australia. Department of Intensive Care, The Austin Hospital, Melbourne, VIC, Australia. Department of Physiotherapy, The Alfred Hospital, Melbourne,VIC, Australia.

Objectives: To evaluate the functional outcome and health-related quality of life of in-hospital cardiac arrest survivors at 6 and 12 months.

Design: A longitudinal cohort study.

Setting: Seven metropolitan hospitals in Australia. Read More

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Enhanced Recovery After Primary Total Hip and Knee Arthroplasty: A Systematic Review.

J Bone Joint Surg Am 2021 Jun 24. Epub 2021 Jun 24.

Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia.

Background: Enhanced Recovery After Surgery (ERAS) has become increasingly implemented to reduce costs, to increase efficiency, and to optimize patient outcomes after a surgical procedure. This study aimed to systematically review the effect of ERAS after primary elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) on hospital length of stay, total procedure-related morbidity, and readmission.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and with guidance from the Cochrane Handbook for Systematic Reviews of Interventions. Read More

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A rare case of retained sabot after close-range shotgun injury.

Surg Case Rep 2021 Jun 24;7(1):148. Epub 2021 Jun 24.

Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109-1998, USA.

Background: Shotgun injuries are a relatively uncommon type of trauma, and therefore may present a challenge in management for trauma surgeons. This is particularly true in the case of surgeons unfamiliar with the unique characteristics of shotgun wounds and the mechanics of shotguns. In many cases, the shot pellets are the primary source of injury. Read More

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Friend or foe? Feeding tube placement at the time of pancreatoduodenectomy: propensity score case-matched analysis.

Surg Endosc 2021 Jun 24. Epub 2021 Jun 24.

Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson Hall 541, Indianapolis, IN, 46202, USA.

Background: The role of concomitant gastrostomy or jejunostomy feeding tube (FT) placement during pancreatoduodenectomy (PD) and its impact on patient outcomes remain controversial.

Methods: NSQIP database was surveyed for patients undergoing PD between 2014 and 2017. FT placement was identified using CPT codes. Read More

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Risk Factors Associated with Ninety Day Readmission in Chronic Obstructive Pulmonary Disease Exacerbation at a Tertiary Care Hospital: A retrospective cohort study.

P Pant A Joshi

Kathmandu Univ Med J (KUMJ) 2020 Oct.-Dec.;18(72):372-375

Department of General Practice and Emergency Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.

Background Chronic obstructive pulmonary disease (COPD) exacerbation is a leading cause of frequent hospital admission. Globally, several studies have reported potential risk factors associated with COPD exacerbations which are largely unknown in Nepalese health care setting. Objective To identify the risk factors associated with hospital readmission within ninety days of discharge in acute COPD exacerbation. Read More

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Outpatient stereotactic brain biopsies.

Neurosurg Rev 2021 Jun 23. Epub 2021 Jun 23.

Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, 47-83, Boulevard de L'Hôpital, 75651 Cedex 13, Paris, France.

Outpatient neurosurgery is rising popularity leading to patients' satisfaction and cost-savings. Although several North-American teams have shown the safety of outpatient stereotactic brain biopsies, few data from other countries with different health care systems are available. We therefore conducted a feasibility and safety study on the outpatient stereotactic brain biopsies. Read More

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Scoring System for Differentiation of Complicated Appendicitis in Pediatric Patients: Appendicitis Scoring System in Children.

Glob Pediatr Health 2021 8;8:2333794X211022268. Epub 2021 Jun 8.

Department of General Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.

Although several scoring systems have been used to differentiate simple acute appendicitis from perforated appendicitis, no particular system has been widely accepted. Therefore, this study aimed to investigate preoperative factors associated with complicated appendicitis and to develop a scoring system that distinguishes complicated appendicitis in children aged <10 years. Patients aged <10 years who underwent surgical treatment for acute appendicitis between 2011 and 2019 were included in this study, after excluding those with insufficient medical records, with other diseases that affect the length of hospitalization, or without formal reports of abdominal computed tomography (CT) or ultrasonography (US). Read More

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Relationship between inpatient satisfaction and the quality of surgery.

Gland Surg 2021 May;10(5):1726-1735

Army Medical University, Chongqing, China.

Background: This study sought to investigate the correlation between inpatient satisfaction and surgical quality evaluation indicators, and explore the factors affecting inpatient satisfaction.

Methods: A total of 5,000 inpatients who underwent surgery at 10 tertiary. A hospital in Chongqing were randomly selected and asked to complete an inpatient satisfaction questionnaire developed by our team in a previous study. Read More

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Hyperkalemia: Major but still understudied complication among heart transplant recipients.

World J Transplant 2021 Jun;11(6):203-211

Department of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706, United States.

Hyperkalemia is a recognized and potentially life-threatening complication of heart transplantation. In the complex biosystem created by transplantation, recipients are susceptible to multiple mechanisms for hyperkalemia which are discussed in detail in this manuscript. Hyperkalemia in heart transplantation could occur pre-transplant, during the transplant period, or post-transplant. Read More

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Outcomes related to anticoagulation management for mechanical valve replacements.

J Thorac Dis 2021 May;13(5):2874-2884

Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Background: This study evaluates anticoagulation management and its impact on longitudinal clinical outcomes in patients undergoing mechanical valve replacement.

Methods: Patients undergoing mechanical mitral valve replacement (MVR) or aortic valve replacement (AVR) from 2010-2018 at a single center were included. Patients were stratified into therapeutic and non-therapeutic anticoagulation groups based on the median percentage of international normalized ratio (INR) values within the reference range (2. Read More

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Detrimental effects of elevated transpulmonary gradient on outcomes following restrictive mitral annuloplasty in patients with pre-existing pulmonary hypertension.

J Thorac Dis 2021 May;13(5):2746-2757

Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

Background: This study retrospectively examined the association between elevated trans-pulmonary gradient (TPG), which reflects pre-capillary contribution to pulmonary hypertension (PH), and postoperative pulmonary hemodynamics and outcomes following restrictive mitral annuloplasty (RMA) in patients with pre-existing PH.

Methods: Pre- and postoperative (1 month) cardiac catheterization was performed in 64 patients with severely impaired left ventricular function (i.e. Read More

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Preoperative Anemia is Associated with Increased Intraoperative Mortality in Patients Undergoing Cardiac Surgery.

Oman Med J 2021 May 31;36(3):e267. Epub 2021 May 31.

Department of Surgery, Division of Cardiothoracic Surgery, Sultan Qaboos University Hospital, Muscat, Oman.

Objectives: We sought to investigate the incidence of preoperative anemia in cardiac surgery and its association with outcomes.

Methods: A retrospective review of clinical, laboratory, and transfusion data for all patients who underwent cardiac surgery at Sultan Qaboos University Hospital between 2008 and 2014 was performed. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin levels < 13 g/dL (males) and < 12 g/dL (females). Read More

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Evaluation of Cost, Payments, Healthcare Utilization, and Perioperative and Post-Operative Outcomes of Patients Treated with Posterior Lumbar Spinal Surgery Using Open versus Minimally Invasive Surgical Approaches.

Med Devices (Auckl) 2021 15;14:173-183. Epub 2021 Jun 15.

DePuy Synthes, Raynham, MA, USA.

Purpose: Minimally invasive surgery (MIS) of the spine has been associated with favorable outcomes compared to open surgery. This study evaluated matched cohorts treated with MIS versus open posterior lumbar fusion for costs, payments, healthcare utilization and outcomes.

Patients And Methods: This study used the Premier Healthcare and IBM MarketScan Commercial and Medicare Databases. Read More

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Exploring instruments used to evaluate potentially inappropriate medication use in hospitalised elderly patients in Kosovo.

Eur J Hosp Pharm 2021 Jul 19;28(4):223-228. Epub 2019 Jul 19.

Faculty of Medicine, Division of Pharmacy, Department of Pharmacy Practice and Pharmaceutical Care, University of Prishtina, Prishtina, Kosovo

Objectives: A number of instruments are used to identify potentially inappropriate medications (PIMs) in the elderly. In this study we identify PIMs in elderly patients and aim to compare three different instruments used to assess PIMs.

Methods: In this prospective cohort study, we compared medications of elderly patients against three commonly used instruments: Beers' list, PRISCUS and STOPP/START, at the point of hospital admission and discharge in the nephrology clinic of Kosovo's largest hospital. Read More

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What is the impact of multimorbidity on the risk of hospitalisation in older adults? A systematic review study protocol.

BMJ Open 2021 Jun 23;11(6):e049974. Epub 2021 Jun 23.

Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia, Goiás, Brazil

Introduction: The development of multiple coexisting chronic diseases (multimorbidity) is increasing globally, along with the percentage of older adults affected by it. Multimorbidity is associated with the concomitant use of multiple medications, a greater possibility of adverse effects, and increased risk of hospitalisation. Therefore, this systematic review study protocol aims to analyse the impact of multimorbidity on the occurrence of hospitalisation in older adults and assess whether this impact changes according to factors such as sex, age, institutionalisation and socioeconomic status. Read More

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Postoperative outcomes of ureteroscopy for pediatric urolithiasis: A secondary analysis of the National Surgical Quality Improvement Program Pediatric.

J Pediatr Urol 2021 Jun 10. Epub 2021 Jun 10.

Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. Electronic address:

Introduction: Incidence of pediatric urinary stone disease (PUSD) has increased over recent decades. Innovations in ureteroscopic technology has expanded the role of endourologic stone management in children. However, there is currently no consensus on the optimal use of ureteroscopy (URS) within the heterogenous PUSD population. Read More

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Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice.

Trop Doct 2021 Jun 24:494755211010002. Epub 2021 Jun 24.

Professor of Surgery, Department of Surgery, 59077Port of Spain General Hospital, Port of Spain, Trinidad & Tobago, West Indies.

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. Read More

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Bridging the Gap Between the Intensive Care Unit and the Acute Medical Care Unit.

Am J Crit Care 2021 May;30(3):193-200

Liron Sinvani is an associate professor, Division of Hospital Medicine, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, and an assistant professor, Feinstein Institutes for Medical Research, Northwell Health.

Background: Despite a growing cohort of intensive care unit (ICU) survivors, little is known about the early ICU aftercare period.

Objective: To identify gaps in early ICU aftercare and factors associated with poor hospital outcomes.

Methods: A multisite, retrospective study (January 1 to December 31, 2017) was conducted among randomly selected patients admitted to the medical ICU and subsequently transferred to acute medical care units. Read More

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Impact of intensive care unit admission during handover on mortality: propensity matched cohort study.

Einstein (Sao Paulo) 2021 18;19:eAO5748. Epub 2021 Jun 18.

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Objective: To investigate the impact of intensive care unit admission during medical handover on mortality.

Methods: Post-hoc analysis of data extracted from a prior study aimed at addressing the impacts of intensive care unit readmission on clinical outcomes. This retrospective, single-center, propensity-matched cohort study was conducted in a 41-bed general open-model intensive care unit. Read More

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Comparing plastic surgery and otolaryngology surgical outcomes and cartilage graft preferences in pediatric rhinoplasty: A retrospective cohort study analyzing 1839 patients.

Medicine (Baltimore) 2021 Jun;100(25):e26393

Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston.

Abstract: Rhinoplasty in children has raised concerns about its safety in the pediatric population. There is scarcity of evidence describing outcomes and surgical techniques performed in pediatric rhinoplasty. We analyzed post-operative complications and cartilage preferences between plastic surgeons and otolaryngologists. Read More

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The Influence of Body Mass Index in Obese and Morbidly Obese Patients on Complications and 30- and 90-day Readmissions Following Lumbar Spine Fusion.

Spine (Phila Pa 1976) 2021 Jul;46(14):965-972

Department of Orthopedic Surgery, Keck School of Medicine of USC, Los Angeles, CA.

Study Design: Retrospective cohort study using the 2013-2017 National Readmission Database.

Objective: The aim of this study was to quantify the influence of body mass index (BMI) on complication and readmission rates following lumbar spine fusion.

Summary Of Background Data: Compared to controls, patients with BMI ≥35 had greater odds of readmission, infection, and wound complications following lumbar spine fusion. Read More

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The Five-item Modified Frailty Index is Predictive of 30-day Postoperative Complications in Patients Undergoing Spine Surgery.

Spine (Phila Pa 1976) 2021 Jul;46(14):939-943

Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY.

Study Design: Retrospective cohort study.

Objective: This study aimed to evaluate the utility of the modified frailty index (mFI-5) in a population of patients undergoing spine surgery.

Summary Of Background Data: The original modified frailty index (mFI-11) published as an American College of Surgeons National Surgical Quality Improvement Program 11-factor index was modified to mFI-5 after variables were removed from recent renditions. Read More

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A-lines and B-lines in patients with acute heart failure.

Eur Heart J Acute Cardiovasc Care 2021 Jun 23. Epub 2021 Jun 23.

Cardiovascular Division, Brigham and Women's Hospital, 360 Longwood Ave., 7th Floor, Boston, MA 02115, USA.

Aims: Lung ultrasound (LUS) relies on detecting artefacts, including A-lines and B-lines, when assessing dyspnoeic patients. A-lines are horizontal artefacts and characterize normal lung, whereas multiple vertical B-lines are associated with increased lung density. We sought to assess the prevalence of A-lines and B-lines in patients with acute heart failure (AHF) and examine their clinical correlates and their relationship with outcomes. Read More

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Early unplanned readmissions following same-admission cholecystectomy for acute biliary pancreatitis.

Surg Endosc 2021 Jun 22. Epub 2021 Jun 22.

Section of Pancreatic Disorders and Advanced Endoscopy, Division of Gastroenterology, Hepatology, & Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH, 43210, USA.

Background: Same-admission cholecystectomy (CCY) is recommended for mild acute biliary pancreatitis (biliary-AP). However, there is a paucity of research investigating reasons for early (30-day) unplanned readmissions in patients who undergo CCY for biliary-AP. Hence, we sought to investigate this gap using a large population database. Read More

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Readmission Following Laparoscopic Adrenalectomy.

Am Surg 2021 Jun 22:31348211029876. Epub 2021 Jun 22.

Department of Surgery, 37316Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.

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Predicting outcomes in older patients undergoing vascular surgery using the Hospital Frailty Risk Score.

Br J Surg 2021 Jun;108(6):659-666

School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.

Background: Frailty may explain why some older patients having vascular surgery are at high risk of adverse outcomes. The Hospital Frailty Risk Score (HFRS) has been designed specifically for use with administrative data and has three categories of frailty risk (low, intermediate and high). The aim of this study was to evaluate the HFRS in predicting mortality, and hospital use in older patients undergoing vascular surgery. Read More

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