Surgery Research and Practice最新文献

{"title":"Surgical Task Shifting Helps Reduce Neonatal Mortality in Ethiopia: A Retrospective Cohort Study.","authors":"Yihun Tariku,&nbsp;Tadele Gerum,&nbsp;Mareshet Mekonen,&nbsp;Haddis Takele","doi":"10.1155/2019/5367068","DOIUrl":"https://doi.org/10.1155/2019/5367068","url":null,"abstract":"<p><strong>Background: </strong>To improve access to surgical service and to reduce neonatal mortality Ethiopia implemented surgical task shifting to nonphysician surgeons (NPSs). We aim at assessing surgical outcomes between NPSs and physician surgeons working in two hospitals.</p><p><strong>Methods: </strong>We collected data from two hospitals on 474 maternal medical records. Completed maternal medical records were included in this study. Data were entered into Epi Info version 7 and analyzed by SPSS version 20 software. Both descriptive and inferential statistics were done. If the 95% confidence interval values exclude the null value, the factor was considered as a significant factor.</p><p><strong>Result: </strong>Totally, 3429 mothers delivered in two hospitals. Of them, 840 (24.5%) delivered by caesarian section (CS), but 474 mothers' records meet the inclusion criteria included in this study. Of 474 CS deliveries, the majority (82%) of them were performed by NPS. Maternal or fetal emergency conditions were the main reasons (92.0%, <i>n</i>=436) for CS. Task shifting does not affect immediate newborn outcomes (ARR, 1.24 (0.55, 2.78)), but duration of hospitalization (ARR: 4 (2.3, 7.5)), condition of the fetus during admission (ARR: 5.22 (2.9, 9.2)), and type of anesthesia used (ARR: 0.2 (0.1, 0.4)) significantly determine the outcome.</p><p><strong>Conclusion: </strong>Surgical task shifting to NPS does not affect the immediate newborn outcome. But general anesthesia is one of the major factors that affects the outcome.</p>","PeriodicalId":30584,"journal":{"name":"Surgery Research and Practice","volume":"2019 ","pages":"5367068"},"PeriodicalIF":0.0,"publicationDate":"2019-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/5367068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37041566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scientometric Analysis of the 50 Most Cited Articles for Reconstruction of the Lower Extremity.","authors":"Zacharia Mbaidjol,&nbsp;Jens Rothenberger,&nbsp;Rajesh Chetany","doi":"10.1155/2019/3068028","DOIUrl":"https://doi.org/10.1155/2019/3068028","url":null,"abstract":"<p><strong>Background: </strong>Lower extremity reconstruction has always been a challenge. Some of the published articles had a major impact on the field but are often not considered as classics because they have fewer citations. We therefore conducted a scientometric analysis of the most cited articles with a focus solely on the lower limb.</p><p><strong>Methods: </strong>A search was conducted on Medline, the Web of Science database, Google Scholar, and Scopus identifying articles relevant to reconstructive surgery of the lower limb. All journals were included with no time frames. Articles relating solely to orthopedics or vascular reconstruction were excluded. The number of citations obtained were then plotted and compared between the different search engines. The mean citation number was calculated by taking into consideration the total number of years since the article's first year of publication. Articles were then ranked and classified according to their authors, their years of publications, and their countries. They were furthermore categorized and analyzed.</p><p><strong>Results: </strong>Highly cited articles were easily retrieved with Google Scholar, mostly published in Plastic and Reconstructive Surgery (<i>n</i> = 37) and were mainly authored by American Medical Centers (<i>n</i> = 22). Fifty-four percent (54%) of these classic articles discussed the design of new flaps or were anatomical studies.</p><p><strong>Conclusions: </strong>We were not able to find a correlation between the year of citation and the number of citations. The citation pattern of a paper cannot be predicted, but a majority of highly cited article allowed the design of new reconstructive techniques.</p>","PeriodicalId":30584,"journal":{"name":"Surgery Research and Practice","volume":"2019 ","pages":"3068028"},"PeriodicalIF":0.0,"publicationDate":"2019-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/3068028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37023988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Proximal Segmental Occlusion of the Internal Carotid Artery.","authors":"Srdjan Babić, Slobodan Tanasković, Mihailo Nešković, Predrag Gajin, Dragoslav Nenezić, Predrag Stevanović, Nikola Aleksić, Milorad Ševković, Nenad Ilijevski, Predrag Matić, Petar Popov, Goran Vučurević, Dragana Unić-Stojanović, Djordje Radak","doi":"10.1155/2019/2976091","DOIUrl":"10.1155/2019/2976091","url":null,"abstract":"<p><strong>Purpose: </strong>To present the feasibility, safety, and efficacy of carotid endarterectomy in patients with type II internal carotid artery occlusions, including the long-term outcomes.</p><p><strong>Methods: </strong>From March 2008 to August 2015, 74 consecutive patients (48 men with a mean age of 65.1 ± 8.06 years) underwent carotid endarterectomy because of internal carotid artery (ICA) segmental occlusions. These were verified with preoperative carotid duplex scans (CDS) and CT angiography (CTA). Also, brain CT scanning was performed in all these patients. The indication for treatment was made jointly by a vascular surgeon, neurologist, and an interventional radiologist in a multidisciplinary team (MDT) context. After successful treatment, all the patients were followed-up at 1, 3, 6, and 12 months, then every 6 months thereafter.</p><p><strong>Results: </strong>The most common symptom at presentation was transient ischaemic attack (TIA) in 49 patients (66.2%), followed by stroke in the past six months in the 17 remaining patients (23%). Revascularisation of the ICA with endarterectomy techniques was performed successfully in all the patients with an average clamp time of 11.9 min. All the procedures were performed under general anaesthesia in combination with a superficial cervical block. The early complication rate was 8.1% and included two cardiac events (2.7%) (one rhythm disorder and one acute coronary syndrome), three TIAs (4.1%), and one intracerebral hemorrhage (1.3%). Only one patient with the intracerebral hemorrhage died 5 days after surgery giving a postoperative mortality of 1.3% for this series. During the follow-up period (mean 50.4 ± 31.3 months), the primary patency rates at 1, 3, 5, and 7 years were 98.4%, 94.9%, 92.9%, and 82.9%, respectively. Likewise, the survival rates were 98.7%, 96.8%, 89%, and 77.6%, respectively. Ultrasound Doppler controls during follow-up detected 8 ICA restenoses; however, only 3 of these patients required further endovascular treatment.</p><p><strong>Conclusions: </strong>Carotid endarterectomy of internal carotid artery (ICA) segmental occlusion is a safe and effective procedure associated with acceptable risk and good long-term results. Therefore, the current guidelines which do not recommend carotid endarterectomy in this patient group should be reassessed, with the requirement for ongoing large-scale randomized controlled trials to compare CEA with best medical therapy in this patient cohort.</p>","PeriodicalId":30584,"journal":{"name":"Surgery Research and Practice","volume":"2019 ","pages":"2976091"},"PeriodicalIF":0.0,"publicationDate":"2019-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36929095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Cohort Study on Rehospitalization following Expanded Criteria Donor Kidney Transplantation.","authors":"Colin Dunn,&nbsp;Emmanuel U Emeasoba,&nbsp;Michael Hung,&nbsp;Ari Holtzman,&nbsp;Eran Bellin,&nbsp;Stuart Greenstein","doi":"10.1155/2018/4879850","DOIUrl":"https://doi.org/10.1155/2018/4879850","url":null,"abstract":"<p><strong>Background: </strong>Expanded criteria donor (ECD) kidneys are commonly used but are associated with increased graft failure. Graft failure is in turn related to rehospitalization within thirty days post transplant. Our goal was to determine whether ECD kidneys independently lead to rehospitalization within 30 days, 1 year, and 2 years after transplant.</p><p><strong>Methods: </strong>All adult first-time recipients of deceased donor kidneys transplanted from 2003-2012 at our center were reviewed. Models included demographics, medical comorbidities, center for disease control high-risk kidney, ECD kidney, ischemia times, cause of renal failure, immunosuppressive regimen, positive psychiatric screening, alcoholism, surgeon, year the transplant was performed, years on dialysis before transplant, and the number of inpatient hospitalizations within 6 months prior to transplant. We conducted Andersen-Gill modeling and propensity score matching followed by logistic regression. We also used multivariable linear regression to predict average length of stay during rehospitalization.</p><p><strong>Results: </strong>More ECD patients had a rehospitalization at 1 year (70.3% versus 59%, log-rank test <i>p</i>=0.014). Thirty-day and 2-year time marks were not significant. Andersen-Gill models predicting successive hospitalizations yielded HR of 1.42 (<i>p</i>=0.002) and 1.32 (<i>p</i>=0.015) for ECD patients at 1 and 2 years of after transplantation, respectively. Propensity score matching and logistic regression showed a significant relative risk of 1.630 at one year (<i>p</i>=0.033) and 1.313 at two years (<i>p</i>=0.268). There was no significant association between ECD and subsequent lengths of hospital stay.</p><p><strong>Conclusion: </strong>Receiving an ECD kidney is independently associated with multiple readmissions within 2 years of transplant but unrelated to length of stay.</p>","PeriodicalId":30584,"journal":{"name":"Surgery Research and Practice","volume":"2018 ","pages":"4879850"},"PeriodicalIF":0.0,"publicationDate":"2018-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/4879850","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36890878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Are Not Clinically Useful in Predicting Prognosis in Early Stage Cervical Cancer.","authors":"Prachratana Nuchpramool,&nbsp;Jitti Hanprasertpong","doi":"10.1155/2018/9162921","DOIUrl":"https://doi.org/10.1155/2018/9162921","url":null,"abstract":"<p><strong>Background: </strong>An objective of this study was to determine the prognostic role of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with cervical cancer (CC) stages IA2-IB1.</p><p><strong>Methods: </strong>The study included 484 patients who underwent radical hysterectomy with pelvic node dissection. The associations of preoperative NLR and PLR with clinicopathologic characteristics and oncological outcomes were analyzed. The cut-off values of NLR (=1.8) and PLR (=119) were set as medians.</p><p><strong>Results: </strong>The clinicopathologic analysis showed that NLR was associated with age (<i>p</i>=0.010), tumor size (<i>p</i>=0.045), and adjuvant treatment (<i>p</i>=0.005), and PLR was associated with only adjuvant treatment (<i>p</i>=0.033). DFS and OS were not significantly different between patients with high and low NLR (<i>p</i>=0.670 and <i>p</i>=0.934) or high and low PLR (<i>p</i>=0.780 and <i>p</i>=0.306). The independent prognostic factors associated with OS were lymph node status and anemia, and with DFS were histology, deep stromal invasion, and lymph node status.</p><p><strong>Conclusions: </strong>NLR and PLR have no use as prognostic biomarker for DFS and OS in early-stage CC. However, NLR and PLR might be of use in determining the risk for adjuvant treatment.</p>","PeriodicalId":30584,"journal":{"name":"Surgery Research and Practice","volume":"2018 ","pages":"9162921"},"PeriodicalIF":0.0,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/9162921","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36853812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salvaging Digital Replantation and Revascularisation: Efficiency of Heparin Solution Subcutaneous Injection.","authors":"Haz Alfeky,&nbsp;Paul McArthur,&nbsp;Yasser Helmy","doi":"10.1155/2018/1601738","DOIUrl":"10.1155/2018/1601738","url":null,"abstract":"<p><strong>Background: </strong>Distal digital replantation and revascularisation remains one of the demanding microsurgical procedures due to the difficulty of vascular anastomosis. Venous congestion is the most commonly encountered problem after replantation due to the difficulty of venous anastomosis in traumatic injuries. Heparin, among other drugs, is commonly used to facilitate venous drainage and prevent thrombosis. However, systemic heparin can be contraindicated in some patients. The senior author has experience of subcutaneous heparin injection for venous congestion in thirteen patients.</p><p><strong>Methods: </strong>An amount of 1 ml of calcium heparin (25,000 U) was mixed in 2.4 ml of normal saline making a solution that has 1000 U per 0.1 ml. 1000 U (0.1 ml) of the solution was injected directly into the congested replanted digits. This was repeated twice daily until venous congestion improved.</p><p><strong>Results: </strong>All the congested replanted digits survived without systemic side effects. There were no local side effects of the treatment. The PT and APTT have shown slight increase but they remained within the normal range. Haemoglobin levels have dropped slightly but no patients were at any risk of developing anaemia or needed blood transfusion.</p><p><strong>Conclusions: </strong>Subcutaneous heparin injections can salvage the replanted digits when venous congestion is a warning flag for replantation failure. It is safe and very efficient in patients where systemic heparin cannot be administered. However, this article shows the results in only thirteen patients which is a small number to show the efficacy, safety, and side effects.</p>","PeriodicalId":30584,"journal":{"name":"Surgery Research and Practice","volume":"2018 ","pages":"1601738"},"PeriodicalIF":0.0,"publicationDate":"2018-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/1601738","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36802941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifications of Surgical Suction Tip Geometry for Flow Optimisation: Influence on Suction-Induced Noise Pollution.","authors":"M G Friedrich,&nbsp;T Tirilomis,&nbsp;J M Kollmeier,&nbsp;Y Wang,&nbsp;G G Hanekop","doi":"10.1155/2018/3074819","DOIUrl":"https://doi.org/10.1155/2018/3074819","url":null,"abstract":"<p><strong>Introduction: </strong>Suction devices for clearing the surgical field are among the most commonly used tools of every surgeon because a better view of the surgical field is essential. Forced suction may produce disturbingly loud noise, which acts as a nonnegligible stressor. Especially, in emergency situations with heavy bleeding, this loud noise has been described as an impeding factor in the medical decision-making process. In addition, there are reports of inner ear damage in patients due to suction noises during operations in the head area. These problems have not been solved yet. The purpose of this study was to analyse flow-dependent suction noise effects of different surgical suction tips. Furthermore, we developed design improvements to these devices.</p><p><strong>Methods: </strong>We compared five different geometries of suction tips using an in vitro standardised setup. Two commercially available standard suction tips were compared to three adapted new devices regarding their flow-dependent (10-2000 mL/min) noise emission (dB, weighting filter (A), distance 10 cm) and acoustic quality of resulting noises (Hamilton fast Fourier analysis) during active suction at the liquid-air boundary. Noise maps at different flow rates were created for all five suction devices, and the proportion of extracted air was measured. The geometries of the three custom-made suction tips (new models 1, 2, and 3) were designed considering the insights after determining the key characteristics of the two standard suction models.</p><p><strong>Results: </strong>The geometry of a suction device tip has significant impact on its noise emission. For the standard models, the frequency spectrum at higher flow rates significantly changes to high-frequency noise patterns (>3 kHz). A number of small side holes designed to prevent tissue adhesion lead to increased levels of high-frequency noise. Due to modifications of the tip geometry in our new models, we are able to achieve a highly significant reduction of noise level at low flow rates (new model 2 vs. standard models <i>p</i> < 0.001) and also the acoustic quality improved. Additionally, we attain a highly significant reduction of secondary air intake (new model 2 vs. the other models <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Improving flow-relevant features of the geometry of suction heads is a suitable way to reduce noise emissions. Optimized suction tips are significantly quieter. This may help us to reduce noise-induced hearing damage in patients as well as stress of medical staff during surgery and should lead to quieter operation theatres overall. Furthermore, the turbulence reduction and reduced secondary air intake during the suction process are expected to result in protective effects on the collected blood and thus could improve the quality of autologous blood retransfusions. We are on the way to evaluate potential benefits.</p>","PeriodicalId":30584,"journal":{"name":"Surgery Research and Practice","volume":"2018 ","pages":"3074819"},"PeriodicalIF":0.0,"publicationDate":"2018-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/3074819","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36802942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"To Investigate the Effect of Colchicine in Prevention of Adhesions Caused by Serosal Damage in Rats\".","authors":"Ihsan Yıldız,&nbsp;Yavuz Savas Koca,&nbsp;Aziz Kemal Emek,&nbsp;Tekinalp Gelen","doi":"10.1155/2018/5128184","DOIUrl":"https://doi.org/10.1155/2018/5128184","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1155/2015/315325.].</p>","PeriodicalId":30584,"journal":{"name":"Surgery Research and Practice","volume":"2018 ","pages":"5128184"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5128184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36740624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Common Bile Duct Stones in Mild Acute Biliary Pancreatitis Using Magnetic Resonance Cholangiopancreatography.","authors":"David Aranovich,&nbsp;Veacheslav Zilbermints,&nbsp;Natalia Goldberg,&nbsp;Oleg Kaminsky","doi":"10.1155/2018/5216089","DOIUrl":"https://doi.org/10.1155/2018/5216089","url":null,"abstract":"<p><strong>Background: </strong>All patients with mild acute biliary pancreatitis should undergo early cholecystectomy. Whether routine common bile duct (CBD) imaging should be employed before the surgical procedure in these patients is a matter of current controversy. The aim of this study was to investigate the rate of detection of CBD stones using magnetic resonance cholangiopancreatography (MRCP) at different time intervals from admission.</p><p><strong>Methods: </strong>From January 1, 2011, through December 31, 2016, 72 patients with acute biliary pancreatitis underwent MRCP. Fifty-six (<i>n</i>=56) of them with mild biliary pancreatitis met the study criteria. The patients were divided into two groups. Group A did not have stones in the CBD (<i>n</i>=45), and Group B had stones in the CBD (<i>n</i>=11). The time from admission to MRCP was divided into several periods (day 1 through day 180), and the presence of the CBD stones on MRCP was weighted against remoteness from admission. Liver chemistry profiles were compared between the groups on admission and before the MRCP.</p><p><strong>Results: </strong>The cumulative rate of choledocholithiasis was 19.7% (Group B, <i>n</i>=11). Forty-five patients (Group A, <i>n</i>=45, 80.3%) did not have gallstones in the CBD. Eight patients with choledocholithiasis (8/56, 14.2%) were detected during the first 10 days from admission out of 27 patients. In patients who underwent MRCP between days 11 and 20, choledocholithiasis was found in two patients (2/56, 3.5%) and in one patient between days 21 and 30 (1/56, 1.8%). No stones were found in patients who underwent MRCP beyond 30 days from admission. Liver chemistry profiles did not show a significant difference in both groups. CBD dilatation was observed at presentation in 11 patients (<i>n</i>=11/56), 6 in Group A (6/45, 13.3%) and 5 in Group B (5/11, 45.5%) (<i>p</i>=0.016).</p><p><strong>Conclusions: </strong>Routine CBD evaluation should be encouraged after mild acute biliary pancreatitis. Early performance of MRCP gives high yield in selecting the patients for endoscopic retrograde cholangiopancreatography (ERCP) before cholecystectomy. A liver chemistry profile either on admission or before MRCP cannot predict the presence of CBD stones.</p>","PeriodicalId":30584,"journal":{"name":"Surgery Research and Practice","volume":"2018 ","pages":"5216089"},"PeriodicalIF":0.0,"publicationDate":"2018-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5216089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36723282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectory Modelling to Assess Trends in Long-Term Readmission Rate among Abdominal Aortic Aneurysm Patients.","authors":"Ahsan Rao,&nbsp;Alex Bottle,&nbsp;Collin Bicknell,&nbsp;Ara Darzi,&nbsp;Paul Aylin","doi":"10.1155/2018/4321986","DOIUrl":"https://doi.org/10.1155/2018/4321986","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to use trajectory analysis to categorise high-impact users based on their long-term readmission rate and identify their predictors following AAA (abdominal aortic aneurysm) repair. Methods. In this retrospective cohort study, group-based trajectory modelling (GBTM) was performed on the patient cohort (2006-2009) identified through national administrative data from all NHS English hospitals. Proc Traj software was used in SAS program to conduct GBTM, which classified patient population into groups based on their annual readmission rates during a 5-year period following primary AAA repair. Based on the trends of readmission rates, patients were classified into low- and high-impact users. The high-impact group had a higher annual readmission rate throughout 5-year follow-up. Short-term high-impact users had initial high readmission rate followed by rapid decline, whereas chronic high-impact users continued to have high readmission rate.</p><p><strong>Results: </strong>Based on the trends in readmission rates, GBTM classified elective AAA repair (<i>n</i>=16,973) patients into 2 groups: low impact (82.0%) and high impact (18.0%). High-impact users were significantly associated with female sex (<i>P</i>=0.001) undergoing other vascular procedures (<i>P</i>=0.003), poor socioeconomic status index (<i>P</i> < 0.001), older age (<i>P</i> < 0.001), and higher comorbidity score (<i>P</i> < 0.001). The AUC for c-statistics was 0.84. Patients with ruptured AAA repair (<i>n</i>=4144) had 3 groups: low impact (82.7%), short-term high impact (7.2%), and chronic high impact (10.1%). Chronic high impact users were significantly associated with renal failure (<i>P</i> < 0.001), heart failure (<i>P</i> = 0.01), peripheral vascular disease (<i>P</i> < 0.001), female sex (<i>P</i> = 0.02), open repair (<i>P</i> < 0.001), and undergoing other related procedures (<i>P</i>=0.05). The AUC for c-statistics was 0.71.</p><p><strong>Conclusion: </strong>Patients with persistent high readmission rates exist among AAA population; however, their readmissions and mortality are not related to AAA repair. They may benefit from optimization of their medical management of comorbidities perioperatively and during their follow-up.</p>","PeriodicalId":30584,"journal":{"name":"Surgery Research and Practice","volume":"2018 ","pages":"4321986"},"PeriodicalIF":0.0,"publicationDate":"2018-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/4321986","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36658925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}