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Hospitalized ulcerative colitis patients have an elevated risk of thromboembolic events

World Journal of Gastroenterology 2009年第8期15卷 927-935页

作者： Jennifer Y Wang Jonathan P Terdiman Eric Vittinghoff Tracy Minichiello Madhulika G Varma Department of surgery University of California San Francisco San Francisco CA 94143 United States Department of Medicine University of California San Francisco San Francisco CA 94143 United States Department of Epidemiology and biostatistics University of California San Francisco San Francisco CA 94143 United States

AIM: To compare thromboembolism rates between hospitalized patients with a diagnosis of ulcerative colitis and other hospitalized patients at high risk for thromboembolism. To compare thromboembolism rates between patients with ulcerative colitis undergoing a colorectal operation and other patients undergoing colorectal operations. METHODS: Data from the National Hospital Discharge Survey was used to compare thromboembolism rates between (1) hospitalized patients with a discharge diagnosis of ulcerative colitis and those with diverticulitis or acute respiratory failure, and (2) hospitalized patients with a discharge diagnosis of ulcerative colitis who underwent colectomy and those with diverticulitis or colorectal cancer who underwent colorectal operations. RESULTS: Patients diagnosed with ulcerative colitis had similar or higher rates of combined venous thromboembolism (2.03%) than their counterparts with diverticulitis (0.76%) or respiratory failure (1.99%), despite the overall greater prevalence of thromboembolic risk factors in the latter groups. Discharged patients with colitis that were treated surgically did not have signifi cantly different rates of venous or arterial thromboembolism than those with surgery for diverticulitis or colorectal ***: Patients with ulcerative colitis who do not undergo an operation during their hospitalization have similar or higher rates of thromboembolism than other medical patients who are considered to be high risk for thromboembolism.

关键词： Ulcerative colitis Thromboembolism Hospitalized patients

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Operative complications and economic outcomes of cholecystectomy for acute cholecystitis

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World Journal of Gastroenterology 2019年第48期25卷 6916-6927页

作者： Christopher P Rice Krishnamurthy B Vaishnavi Celia Chao Daniel Jupiter August B Schaeffer Whitney R Jenson Lance W Griffin William J Mileski School of Medicine University of Texas Medical BranchGalvestonTX 77555United States Department of surgery University of Texas Medical BranchGalvestonTX 77555United States Department of biostatistics University of Texas Medical BranchGalvestonTX 77555United States

BACKGROUND Recent management of acute cholecystitis favors same admission(SA)or emergent cholecystectomy based on overall shorter hospital stay and therefore cost *** adopted the practice of SA cholecystectomy for the treatment of acute cholecystitis at our tertiary care center and wanted to evaluate the economic benefit of this *** hypothesized that the existence of complications,particularly among patients with a higher degree of disease severity,during SA cholecystectomy could negate the cost *** To compare complication rates and hospital costs between SA vs delayed cholecystectomy among patients admitted emergently for acute *** Under an IRB-approved protocol,complications and charges for were obtained for SA,later after conservative management(Delayed),or elective cholecystectomies over an 8.5-year *** were identified using the acute care surgery registry and billing *** was retrieved via EMR,operative logs,and Revenue Cycle *** severity of acute cholecystitis was graded according to the Tokyo ***18 categorizes acute cholecystitis by Grades 1,2,and 3 representing mild,moderate,and severe,*** were analyzed withχ2,Fisher’s exact test,ANOVA,ttests,and logistic regression;significance was set at P<*** Four hundred eighty-six(87.7%)underwent a SA while 68 patients(12.3%)received Delayed *** rates were increased after SA compared to Delayed cholecystectomy(18.5%vs 4.4%,P=0.004).The complication rates of patients undergoing delayed cholecystectomy was similar to the rate for elective cholecystectomy(7.4%,P=0.35).Mortality rates were 0.6%vs 0%for SA vs *** with moderate disease(Tokyo 2)suffered more complications among SA while none who were delayed experienced a complication(16.1%vs 0.0%,P<0.001).Total hospital charges for SA cholecystectomy were increased compared to a Delayed approach($44500±$59000 vs$35300±$16700,P=

关键词： Acute cholecystitis Tokyo guidelines Cholecystectomy Complications Delayed cholecystectomy

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Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients： Subgroup Meta-analysis

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Chinese Medical Journal 2017年第13期130卷 1586-1594页

作者： Xiao-Han Chen Sehee Kim Xiao-Xi Zeng Zhi-Bing Chen Tian-Lei Cui Zhang-Xue HU Yi Li Ping Fu Department of Nephrology Kidney Research Institute West China Hospital Sichuan University Chengdu Sichuan 610041 China Department of biostatistics University of Michigan School of Public Health Ann Arbor Michigan 48109 USA West China biostatistics and Cost-benefit Analysis Center of Sichuan University Chengdu Sichuan 610041 China Department of Burn and Plastic surgery Chengdu Second People's Hospital Chengdu Sichuan 610017 China Kidney Epidemiology and Cost Center University of Michigan Ann Arbor Michigan 48109 USA

Background： Catheter-based renal denervation （RDN） is a novel treatment tbr resistant hypertension （RH）. A recent meta-analysis reported that RDN did not significantly reduce blood pressure （BP） based on the pooled effects with mild to severe heterogeneity. The aim of the present study was to identify and reduce clinical sources of heterogeneity and reassess the safety and efficacy of RDN within the identified homogeneous subpopulations. Methods： This was a meta-analysis of 9 randomized clinical trials （RCTs） among patients with RH up to June 2016. Sensitivity analyses and subgroup analyses were extensively conducted by baseline systolic blood pressure （SBP） level, antihypertensive medication change rates, and coronary heart disease （CHD）. Results： In all patients with RH, no statistical differences were found in mortality, severe cardiovascular events rate, and changes in 24-11 SBP and office SBP at 6 and 12 months. However, subgroup analyses showed significant differences between the RDN and control groups. In the subpopulations with baseline 24-h SBP 〉 155 mmHg （ 1 mmHg = 0.133 kPa） and the infrequently changed medication, the use of RDN resulted in a significant reduction in 24-h SBP level at 6 months （P = 0.100 and P = 0.009, respectively）. Subgrouping RCTs with a higher prevalent CHD in control showed that the control treatment was significantly better than RDN in office SBP reduction at 6 months （P 〈 0.001 ）. Conclusions： In all patients with RH, the catheter-based RDN is not more effective in lowering ambulatory or office BP than an optimized antihypertensive drug treatment at 6 and 12 months. However, among RH patients with higher baseline SBP, RDN might be more effective in reducing SBR

关键词： Antihypertensive Treatment Hypertension Randomized Controlled Trials Renal Denervation Subgroup Meta-analysis

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Practice patterns and outcomes of equivocal bone scans for patients with castration-resistant prostate cancer: Results from SEARCH

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Asian Journal of Urology 2019年第3期6卷 242-248页

作者： Brian T.Hanyok Mary M.Everist Lauren E.Howard Amanda M.De Hoedt William J.Aronson Matthew R.Cooperberg Christopher J.Kane Christopher L.Amling Martha K.Terris Stephen J.Freedland Urology Section Department of SurgeryVeterans Affairs Medical CenterDurhamNCUSA New York Medical College ValhallaNYUSA Department of biostatistics and Bioinformatics Duke University School of MedicineDurhamNCUSA Urology Section Department of SurgeryVeterans Affairs Medical CenterGreater Los AngelesLos AngelesCAUSA Department of Urology University of California at Los Angeles Medical CenterLos AngelesCAUSA departments ofUrology and Epidemiology&biostatistics University of CaliforniaSan FranciscoCAUSA Urology Section Department of SurgeryVeterans Affairs Medical CenterSan FranciscoCAUSA Division of Urology Department of SurgeryUniversity of California at San Diego Medical CenterSan DiegoCAUSA Division of Urology Department of SurgeryOregon Health&Science UniversityPortlandORUSA Urology Section Division of SurgeryVeterans Affairs Medical CenterAugustaGAUSA Division of Urologic surgery Department of SurgeryMedical College of GeorgiaAugustaGAUSA Division of Urology Department of SurgerySamuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesCAUSA Center for Integrated Research in Cancer and Lifestyle Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesCAUSA

Objective:To review follow-up imaging after equivocal bone scans in men with castration resistant prostate cancer(CRPC)and examine the characteristics of equivocal bone scans that are associated with positive follow-up ***:We identified 639 men from five Veterans Affairs Hospitals with a technetium-99m bone scan after CRPC diagnosis,of whom 99(15%)had equivocal *** with equivocal scans were segregated into“high-risk”and“low-risk”subcategories based upon wording in the bone scan *** follow-up imaging(bone scans,computed tomography[CT],magnetic resonance imaging[MRI],and X-rays)in the 3 months after the equivocal scan were *** were compared between patients with a positive *** follow-up imaging after an equivocal bone ***:Of 99 men with an equivocal bone scan,43(43%)received at least one follow-up imaging test,including 32/82(39%)with low-risk scans and 11/17(65%)with high-risk scans(p=0.052).Of follow-up tests,67%were negative,14%were equivocal,and 19%were *** those who underwent follow-up imaging,3/32(9%)low-risk men had metastases vs.5/11(45%)high-risk men(p=0.015).Conclusion:While 19%of all men who received follow-up imaging had positive follow-up imaging,only 9%of those with a low-risk equivocal bone scan had metastases versus 45%of those with *** preliminary findings,if confirmed in larger studies,suggest follow-up imaging tests for low-risk equivocal scans can be delayed while high-risk equivocal scans should receive follow-up imaging.

关键词： Castration-resistant prostate cancer Equivocal test result Bone scan Radiology report Follow-up imaging Neoplasm metastasis

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SARS-CoV-2 outbreak impact on a trauma unit

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World Journal of Orthopedics 2021年第10期12卷 751-759页

作者： Sarah Mills Aitor Ibarzábal-Gil José M Martínez-Diez Javier Pallarés-Sanmartín Carlos Kalbakdij-Sánchez Juan C Rubio-Suárez Itsaso Losantos-García E Carlos Rodríguez-Merchán Department of Orthopedic surgery La Paz University HospitalMadridSpain Department of biostatistics La Paz University HospitalMadrid 28046Spain Osteoarticular surgery Research Hospital La Paz Institute for Health Research–IdiPAZ(La Paz University Hospital–Autonomous University of Madrid)MadridSpain

BACKGROUND From February 2020 onwards,our country has been hit by the coronavirus severe acute respiratory syndrome-2(SARS-CoV-2)*** a glance,hospitals became overrun and had to reformulate all the assistance guidelines,focusing on the coronavirus disease *** year after the start of the pandemic,we present the results of a morbimortality *** To analyze how our department was affected by the outbreak in terms of morbimortality,and to analyze demographic data,admission to hospital-related data,and subgroups analyses for patients with hip fractures and *** We designed a study comparing data from patients who were admitted to our unit due to a lower limb fracture or a high energy trauma during the pandemic(from March to April 2020)to those admitted during the same period in 2019 before the *** the pandemic *** cohorts completed a minimum of 6 mo of *** The number of patients admitted to hospital in 2020 was nearly half of those in *** fractures in the elderly represented 52 out of 73 of the admitted *** patients had a positive test result for SARS-CoV-2 *** with SARS-CoV-2 infection were admitted to the hospital for a longer time than the non-infected(P<0.001),and had a higher mortality rate during hospitalization and follow-up(P=0.02).Patients with a hip fracture associated with a severe respiratory syndrome were mostly selected for conservative treatment(P=0.03).CONCLUSION Mortality and readmission rates were higher in the 2020 cohort and during follow-up,in comparison with the cohort in 2019.

关键词： Trauma department COVID-19 pandemic SARS-CoV-2 outbreak Hip fractures Morbimortality Polytraumatic patients

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Diagnosis of morbid obesity may not impact healthcare utilization for orthotopic liver transplantation:A propensity matched study

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World Journal of Hepatology 2017年第12期9卷 595-602页

作者： Joshua R Peck Nicholas Latchana Anthony Michaels Adam J Hanje Alice Hinton Elmahdi A Elkhammas Sylvester M Black Khalid Mumtaz Division of Gastroenterology Hepatology and Nutritionthe Ohio State University Wexner Medical Center Department of surgery the Ohio State University Wexner Medical Center Department of biostatistics the Ohio State University Wexner Medical Center

AIM To study mortality, length of stay, and total charges in morbidly obese adults during index hospitalization for orthotopic liver *** The Nationwide Inpatient Sample was queried to obtain demographics, healthcare utilization, post orthotopic liver transplantation(OLT) complications, and short term outcomes of OLT performed from 2003 to 2011(n = 46509). We divided patients into those with [body mass index(BMI) ≥ 40] and without(BMI < 40) morbid obesity. Multivariable logistic regression analysis was performedto characterize differences in in-hospital mortality, length of stay(LOS), and charges for OLT between patients with and without morbid obesity after adjusting for significant confounders. Additionally, propensity matching was performed to further validate the *** Of the 46509 patients who underwent OLT during the study period, 818(1.8%) were morbidly obese. Morbidly obese recipients were more likely to be female(46.8% vs 33.4%, P = 0.002), Caucasian(75.2% vs 67.8%, P = 0.002), in the low national income quartile(32.3% vs 22.5%, P = 0.04), and have ≥ 3 comorbidities(modified Elixhauser index; 83.9% vs 45.0%, P < 0.001). Morbidly obese patient also had an increase in procedure related hemorrhage(P = 0.028) and respiratory complications(P = 0.043). Multivariate and propensity matched analysis showed no difference in mortality(OR: 0.70; 95%CI: 0.27-1.84, P = 0.47), LOS(β:-4.44; 95%CI:-9.93, 1.05, P = 0.11) and charges for transplantation(β: $15693; 95%CI:-51622-83008, P = 0.64) between the two groups. Morbidly obese patients were more likely to have transplants on weekdays(81.7%) as compared to those without morbid obesity(75.4%, P = 0.029).CONCLUSION Morbid obesity may not impact in-hospital mortality and health care utilization in OLT recipients. However, morbidly obese patients may be selected after careful assessment of co-morbidities.

关键词： Deceased donors Outcome Complications Economics Selection criteria

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Compliance with enhanced recovery after surgery predicts long-term outcome after hepatectomy for cholangiocarcinoma

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World Journal of Gastrointestinal surgery 2023年第3期15卷 362-373页

作者： Chaowasaporn Jongkatkorn Vor Luvira Chalisa Suwanprinya Kantaruthai Piampatipan Natwutpong Leeratanakachorn Theerawee Tipwaratorn Attapol Titapun Tharatip Srisuk Suapa Theeragul Apiwat Jarearnrat Vasin Thanasukarn Ake Pugkhem Narong Khuntikeo Chawalit Pairojkul Supot Kamsa-Ard Vajarabhongsa Bhudhisawasdi Department of surgery Faculty of MedicineKhon Kaen UniversityKhon Kaen 40002Thailand Department of surgery Saraburi HospitalSaraburi 18000Thailand Department of Pathology Faculty of MedicineKhon Kaen UniversityKhon Kaen 40002Thailand Department of Epidemiology and biostatistics Faculty of Public HealthKhon Kaen UniversityKhon Kaen 40002Thailand

BACKGROUND Enhanced recovery after surgery(ERAS)program has been proved to improve postoperative outcome for many surgical procedures,including liver *** was limited evidence regarding the feasibility and benefit of ERAS in patients who underwent liver resection for *** To evaluate the feasibility of ERAS in patients who underwent liver resection for cholangiocarcinoma and its association with patient *** We retrospectively analyzed 116 cholangiocarcinoma patients who underwent hepatectomy at Srinagarind Hospital,Khon Kaen University between January 2015 and December *** primary outcome was the compliance with *** determine the association between ERAS compliance and patient *** patients were categorized into those adhering more than and equal to 50%(ERAS≥50),and below 50%(ERAS<50)of all *** on type of surgical procedure,preoperative and postoperative care,tumor location,postoperative laboratory results,and survival time were *** compliance with ERAS was measured by the percentage of ERAS items *** Kaplan-Meier curve was used for survival *** The median percentage of ERAS goals achieved was 40%(±12%).Fourteen patients(12.1%)were categorized into the ERAS≥50 group,and 102 patients were in the ERAS<50 *** hospital stay was significantly shorter in the ERAS≥50 group[8.9 d,95%confidence interval(CI):7.3-10.4 d]than in the ERAS<50 group(13.7 d,95%CI:12.2-15.2 d)(P=0.0217).No hepatobiliary-related complications or in-hospital mortality occurred in the ERAS≥50 *** survival was significantly higher in the ERAS≥50 *** median survival of the patients in the ERAS<50 group was 1257 d(95%CI:853.2-1660.8 d),whereas that of the patients in the ERAS≥50 group was not *** Overall ERAS compliance for patients who underwent liver resection for cholangiocarcinoma is *** ERAS compliance could predict in-hospital,short-term,an

关键词： Enhanced recovery program after surgery Cholangiocarcinoma Hepatectomy Survival Enhanced recovery after surgery Outcome

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Wound Inflammatory Cells after Cardiac surgery and the Patients’ Survival

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Surgical Science 2016年第12期7卷 511-521页

作者： J. A. Viljanto E. S. Lö yttyniemi T. J. A. Savunen Department of surgery Turku University Hospital Turku Finland Department of biostatistics University of Turku Turku Finland

Objective: To find out possible associations between wound inflammatory cell response and the patients’ survival. Background: Several articles have written about the effects of single inflammatory cell types on wound healing but little is known about the interaction of these cells on survival. The methods used in this study have made possible this kind of exploration. Methods: One hundred patients, aged from 41 to 78 years, underwent open heart surgery in the years 1998-1999 and were studied by using the Cellstick device for harvesting wound inflammatory cells during the first 24 hours after surgery. The results of the differential count were computerized by using artificial neural network for obtaining wound inflammatory cell node (WICN). The patients were followed up for sixteen years or to the death. WICN values were compared with the patients’ survival. Results: WICN reflects survival better than any single type of wound inflammatory cells alone (HR = 3.1;p = 0.081 for low/high WICN at 10 year survival). From several clinical characteristics diabetes only predicted shorter survival time (HR = 5.5;p = 0.014 for 10 year survival) better than WICN. Conclusion: These results support the view that regularly timed cell-to-cell ratios in wound inflammation, most often seen as high WICN, reflect beneficial survival. Instead, aberrant counts of inflammatory cells in the wounds lead to low WICN and often to the patients’ shorter survival.

关键词： Surgical Wounds Inflammatory Cells Survival

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Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction

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World Journal of Clinical Cases 2021年第1期9卷 36-46页

作者： Yan-Yu Chen Yi-Fan Cheng Quan-Peng Wang Bo Ye Chong-Jie Huang Chong-Jun Zhou Mao Cai Yun-KuiYe Chang-Bao Liu Department of Anorectal surgery The 2^nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhou 325000Zhejiang ProvinceChina Department of biostatistics School of Public HealthState University of New York at AlbanyAlbanyNY 12206United States

BACKGROUND Hemorrhoidal prolapse is a common benign disease with a high *** treatment procedure for prolapse and hemorrhoids(PPH)remains an operative method used for internal hemorrhoid *** it is related to less posoperative pain,faster recovery and shorter hospital stays,the postoperative recurrence rate is higher than that of the Milligan-Morgan hemorrhoidectomy(MMH).We have considered that recurrence could be due to shortage of the pulling-up *** issue may be overcome by using lower purse-string sutures[modified-PPH(M-PPH)].AIM To compare the therapeutic effects and the patients’satisfaction after M-PPH,PPH and *** This retrospective cohort study included 1163 patients(M-PPH,461;original PPH,321;MMH,381)with severe hemorrhoids(stage III/IV)who were admitted to The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from 2012 to *** postoperative complications,efficacy,postoperative anal dysfunction and patient satisfaction were compared among the three *** criteria were used to assess short-and long-term postoperative complications.A visual analog scale was used to evaluate postoperative ***-up was conducted 5 years *** Length of hospital stay and operating time were significantly longer in the MMH group(8.05±2.50 d,19.98±4.21 min;P<0.0001)than in other *** incidence of postoperative anastomotic bleeding was significantly lower after MPPH than after PPH or MMH(1.9%,5.1%and 3.7%;n=9,16 and 14;respectively).There was a significantly higher rate of sensation of rectal tenesmus after M-PPH than after MMH or PPH(15%,8%and 10%;n=69,30 and 32;respectively).There was a significantly lower rate of recurrence after M-PPH than after PPH(8.7%and 18.8%,n=40 and 61;P<0.0001).The incidence of postoperative anal incontinence differed significantly only between the MMH and M-PPH groups(1.3%and 4.3%,n=5 and 20;P=0.04).Patient satisfaction was significant

关键词： Hemorrhoids Milligan-Morgan hemorrhoidectomy Postoperative complications Procedure for prolapse and hemorrhoids Recurrence Patient satisfaction

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儿童阑尾穿孔以及阴性阑尾切除术的危险与医院、患者特征

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美国医学会杂志（中文版） 2006年第1期25卷 11-16页

作者： Todd A. Ponsky Zhihuan J. Huang Kory Kittle Martin R. Eichelberger James C. Gilbert Fredrick Brody Kurt D, Newman 周静（译）祝学光（校） departments of surgery departments of surgery and biostatistics Children＇s National Medical Center and George Washington University Medical Center Washington DC and Child Health Corporation of America Overland Park Kan 不详

背景：即使作了努力，儿童阑尾穿孔和阴性阑尾切除术的发生率依然居高不下。这两种结局均被用作衡量医院质量的指标。对影响其发生率的因素还知之甚少。目的：研究儿童阑尾穿孔和阴性阑尾切除术的发生率与医院、患者特征的相关性。设计... 详细信息

背景：即使作了努力，儿童阑尾穿孔和阴性阑尾切除术的发生率依然居高不下。这两种结局均被用作衡量医院质量的指标。对影响其发生率的因素还知之甚少。目的：研究儿童阑尾穿孔和阴性阑尾切除术的发生率与医院、患者特征的相关性。设计、地点和患者：利用儿童健康信息系统数据库，对1997～2002年美幽36家儿童医院24411例5—17岁行阑尾切除术患者的资料进行同顾性分析。主要结局指标：阴性阑尾切除术和阑尾穿孔的发生率；不同医院、年龄、种族、健康保险状况以及医院财政年度和阑尾切除术数量下，阴性阑尾切除术、阑尾穿孔的优势比（odds ratio，OR）。阴性阑尾切除率的定义为行阑尾切除术但无阑尾炎的例数除以阑尾切除的总例数。结果：中位阴性阑尾切除率为3．06％（范围1％-12％），中位阑尾穿孔的发生率为35．08％（范围22％-62％）。与白种患儿比较，亚洲裔患儿（OR，1．66；95％可信区间[CI]，1．24—2．23）和黑种患儿（OR，1．13；95％CI，1.01—1.30）发生阑尾穿孔的校正后优势比均较高。与拥有个人健康保险的儿童相比较，没有健康保险的患儿以及只有公共保险儿童的阑尾穿孔比例增高（自我保险者：校正后OR，1．36；95％CI，1．22—1．53；公共保险者：校正后OR，1．48；95％CI，1．34—1．64）。阴性阑尾切除率与种族、健康保险状况或医院阑尾穿孔发生率没有相关性。阴性阑尾切除率随着医院阑尾切除数量的增多而有所改善。结论：学龄儿童的阑尾穿孔发生率与种族和健康保险状况相关，而与阴性阑尾切除率无关，因此更可能与某些入院前因素，如是否能得到治疗、治疗的质量以及患者或医生受教育的情况等相关。

关键词：阑尾切除术阑尾穿孔医院质量儿童健康患者特征阴性阑尾切除率健康保险信息系统数据库发生率

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