Clinical Outcomes Improvement and Perioperative Management of Surgical Patients

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (20 December 2023) | Viewed by 17307

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Guest Editor
Department of Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece
Interests: pancreatic surgery; liver surgery; bariatric surgery; surgical oncology
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Special Issue Information

Dear Colleagues,

The art and science of clinical outcomes analysis, quality improvement, perioperative management of surgical patients, and patient safety continue to evolve at an increasingly rapid pace. In fact, over the years, novel concepts have arisen (risk stratification, shared decision making, interdisciplinary meetings, prehabilitation, etc.), new initiatives have taken shape (e.g., state/nation-wide or international clinical databases), and new technologies and methods have been adopted across all surgical specialties (e.g., minimally invasive or robotic approaches).

In order to care for our patients, raise the standards of healthcare services, and be successful in today’s and tomorrow’s rapidly changing healthcare environment, understanding and evolving these topics represents an essential duty of all surgeons, physicians, and professionals related to surgical patients. In this context, we call all surgeons, physicians, and professionals from all the associated disciplines involved in the perioperative pathway of surgical patients (surgeons, anesthesiologists, radiologists, intensivists, cardiologists, oncologists, pulmonologists, nurses, physiotherapists, nutritionists, etc.) to contribute to this Special Issue. Our vision is to provide the best currently available evidence on this important topic, thus providing all the necessary information to clinicians on core concepts in the perioperative management of surgical patients.

Dr. Dimitrios E. Magouliotis
Prof. Dr. Dimitris Zacharoulis
Guest Editors

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Keywords

  • clinical outcomes
  • surgery
  • quality
  • quality of life
  • quality improvement
  • perioperative
  • morbidity
  • postoperative care

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Published Papers (13 papers)

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Editorial

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4 pages, 473 KiB  
Editorial
Surgery and Reason: The End of History and the Last Surgeon
by Dimitrios E. Magouliotis, Thanos Athanasiou and Dimitrios Zacharoulis
J. Clin. Med. 2023, 12(17), 5708; https://doi.org/10.3390/jcm12175708 - 01 Sep 2023
Viewed by 1642
Abstract
Arguably, Georg Wilhelm Friedrich Hegel has been one of the most influential philosophers of the 19th century [...] Full article
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Research

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12 pages, 218 KiB  
Article
Three Years of Continuous Vital Signs Monitoring on the General Surgical Ward: Is It Sustainable? A Qualitative Study
by Harm H. J. van Noort, Femke L. Becking-Verhaar, Wilmieke Bahlman-van Ooijen, Maarten Pel, Harry van Goor and Getty Huisman-de Waal
J. Clin. Med. 2024, 13(2), 439; https://doi.org/10.3390/jcm13020439 - 13 Jan 2024
Viewed by 879
Abstract
Continuous monitoring of vital signs using a wireless wearable device was implemented in 2018 at a surgical care unit of an academic hospital. This study aimed at gaining insight into nurses’ and patients’ perspectives regarding the use and innovation of a continuous vital [...] Read more.
Continuous monitoring of vital signs using a wireless wearable device was implemented in 2018 at a surgical care unit of an academic hospital. This study aimed at gaining insight into nurses’ and patients’ perspectives regarding the use and innovation of a continuous vital signs monitoring system, three years after its introduction. This qualitative study was performed in a surgical, non-intensive care unit of an academic hospital in 2021. Key-user nurses (nurses with additional training and expertise with the device) and patients were selected for semi-structured interviews, and nurses from the ward were selected for a focus group interview using a topic list. Transcripts of the audio tapes were deductively analysed using four dimensions for adoptions of information and communication technologies (ICT) devices in healthcare. The device provided feelings of safety for nurses and patients. Nurses and patients had a few issues with the device, including the size and the battery life. Nurses gained knowledge and skills in using the system for measurement and interpretations. They perceived the system as a tool to improve the recognition of clinical decline. The use of the system could be further developed regarding the technical device’s characteristics, nurses’ interpretation of the data and the of type of alarms, the information needs of patients, and clarification of the definition and standardization of continuous monitoring. Three years after the introduction, wireless continuous vital signs monitoring is the new standard of care according to the end-users at the general surgical ward. Full article
10 pages, 775 KiB  
Article
Comparison of Fibrinogen Concentrate and Cryoprecipitate on Major Thromboembolic Events after Living Donor Liver Transplantation
by Jae-Hwan Kim, Kyoung-Sun Kim, Hye-Mee Kwon, Sung-Hoon Kim, In-Gu Jun, Jun-Gol Song and Gyu-Sam Hwang
J. Clin. Med. 2023, 12(23), 7496; https://doi.org/10.3390/jcm12237496 - 04 Dec 2023
Viewed by 833
Abstract
(1) Background: Liver transplantation (LT) is associated with significant hemorrhage and massive transfusions. Fibrinogen replacement has a key role in treating massive bleeding during LT and hypofibrinogenemia is treated by fibrinogen concentrate or cryoprecipitate. However, these two products are known to be associated [...] Read more.
(1) Background: Liver transplantation (LT) is associated with significant hemorrhage and massive transfusions. Fibrinogen replacement has a key role in treating massive bleeding during LT and hypofibrinogenemia is treated by fibrinogen concentrate or cryoprecipitate. However, these two products are known to be associated with major thromboembolism events (MTEs). We aimed to compare the effect of fibrinogen concentrate and cryoprecipitate on MTEs in living donor LT (LDLT) recipients. (2) Methods: We analyzed 206 patients who underwent LDLT between January 2021 and March 2022. The patients were divided into two groups according to fibrinogen concentrate or cryoprecipitate use. We compared the incidence of MTEs between the two groups. In addition, we performed multiple logistic regression analyses to identify the risk factors for MTEs. (3) Results: There was no significant difference in the incidence of MTEs (16 [14.7%] vs. 14 [14.4%], p = 1.000) between the cryoprecipitate group and fibrinogen concentrate group. In the multivariate analysis, cryoprecipitate (OR 2.09, 95%CI 0.85–5.11, p = 0.107) and fibrinogen concentrate (OR 2.05, 95%CI 0.82–5.12, p = 0.126) were not significantly associated with MTEs. (4) Conclusions: there was no significant difference in the incidence of MTEs between cryoprecipitate and fibrinogen concentrate in LDLT recipients. Full article
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12 pages, 664 KiB  
Article
Younger Age and Parenchyma-Sparing Surgery Positively Affected Long-Term Health-Related Quality of Life after Surgery for Pancreatic Neuroendocrine Neoplasms
by Anna Caterina Milanetto, Claudia Armellin, Gloria Brigiari, Giulia Lorenzoni and Claudio Pasquali
J. Clin. Med. 2023, 12(20), 6529; https://doi.org/10.3390/jcm12206529 - 14 Oct 2023
Viewed by 640
Abstract
(1) Background: Patients with pancreatic Neuroendocrine Neoplasms (PanNENs) often have a long overall survival. We evaluated determinants of quality of life (QoL) after surgery for PanNENs. (2) Methods: Patients operated on for a PanNEN in our center (1990–2021) received three EORTC QoL questionnaires [...] Read more.
(1) Background: Patients with pancreatic Neuroendocrine Neoplasms (PanNENs) often have a long overall survival. We evaluated determinants of quality of life (QoL) after surgery for PanNENs. (2) Methods: Patients operated on for a PanNEN in our center (1990–2021) received three EORTC QoL questionnaires (QLQ-C30, QLQ-GI.NET21, QLQ-PAN26). Six domains were selected as outcome variables (global QoL, physical function -PF, social function -SF, disease-related worries -DRWs, pain, upper-gastrointestinal (GI) symptoms) and evaluated in relation to the clinical variables. Statistical analysis was performed using R software v 4.2.2. (3) Results: One hundred and four patients enrolled showed a good global QoL (median 83.3). Old age was a determinant of worse global QoL (p 0.006) and worse PF (p 0.003). Multiple comorbidities (p 0.002) and old age (p 0.034) were associated with pain, while male gender was related to better PF (p 0.007) and less pain (p 0.012). Patients who had undergone parenchyma-sparing surgery demonstrated better PF (p 0.037), better SF (p 0.012), and less upper-GI symptoms (p 0.047). At multivariable analysis, age (p 0.005) and type of surgery (p 0.028) were confirmed as determinants of global QoL. (4) Conclusions: In patients operated on for a PanNEN, a good HRQoL is generally reported; notably, younger age and parenchyma-sparing surgery seem to positively affect HRQoL. Full article
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11 pages, 863 KiB  
Article
Comparison of Two Techniques Performing the Supine-to-Sitting Postural Change in Patients with Sternotomy
by Marica Giardini, Marco Guenzi, Ilaria Arcolin, Marco Godi, Massimo Pistono and Marco Caligari
J. Clin. Med. 2023, 12(14), 4665; https://doi.org/10.3390/jcm12144665 - 13 Jul 2023
Cited by 1 | Viewed by 861
Abstract
Patients with sternotomy are advised to follow sternal precautions to avoid the risk of sternal complications. However, there are no standard recommendations, in particular to perform the supine-to-sitting postural change, where sternal asymmetrical force may be applied. The aim of this study was [...] Read more.
Patients with sternotomy are advised to follow sternal precautions to avoid the risk of sternal complications. However, there are no standard recommendations, in particular to perform the supine-to-sitting postural change, where sternal asymmetrical force may be applied. The aim of this study was to compare the rotational movement and the use of a tied rope (individual device for supine-to-sitting, “IDSS”) to perform the supine-to-sitting postural change. A total of 92 patients (26% female) admitted to a rehabilitative post-surgery ward with sternotomy were assessed for sternal instability. Levels of pain and perceived effort during the two modalities of postural change and at rest were assessed. Patients reported higher values of pain and perceived effort (both p < 0.0005) during rotational movement with respect to the use of the IDSS. Moreover, patients with sternal instability (14%) and female patients with macromastia (25%) reported higher pain than those stable or without macromastia (both p < 0.05). No other risk factors were associated with pain. Thus, the IDSS seems to reduce the levels of pain and perceived effort during the supine-to-sitting postural change. Future studies with quantitative assessments are required to suggest the adoption of this technique, mostly in patients with high levels of pain or with sternal instability. Full article
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12 pages, 1125 KiB  
Article
The Impact of Bariatric Surgery on Quality of Life in Patients with Obesity
by Radu Petru Soroceanu, Daniel Vasile Timofte, Radu Danila, Sergiu Timofeiov, Roxana Livadariu, Ancuta Andreea Miler, Bogdan Mihnea Ciuntu, Daniela Drugus, Laura Elisabeta Checherita, Ilie Cristian Drochioi, Mihai Liviu Ciofu and Doina Azoicai
J. Clin. Med. 2023, 12(13), 4225; https://doi.org/10.3390/jcm12134225 - 23 Jun 2023
Cited by 4 | Viewed by 2177
Abstract
Obesity has become a widespread health problem influencing people’s health, general well-being, and healthcare costs. It also represents an important risk factor for multiple comorbidities and malignancies. Objectives: the primary objective of this study was to provide notable insights to healthcare professionals regarding [...] Read more.
Obesity has become a widespread health problem influencing people’s health, general well-being, and healthcare costs. It also represents an important risk factor for multiple comorbidities and malignancies. Objectives: the primary objective of this study was to provide notable insights to healthcare professionals regarding the management of patients with obesity, to highlight the effectiveness of bariatric surgical methods in losing excess weight, and to establish the relationship between weight loss and changes in quality of life (QoL). Material and methods: our study evaluated the QoL of 76 patients following bariatric surgery at different postoperative stages using the 36-Item Short Form Survey (SF-36) and The World Health Organization Quality of Life—BREF (WHOQOL-BREF) questionnaires. Results: regarding the type of bariatric procedure performed, out of the 76 respondents, 39.47% underwent gastric bypass surgery (RYGB), 56.57% underwent sleeve gastrectomy (LSG), and only 3.94% underwent single anastomosis duodeno-ileal switch (SADI-S). Pertaining to the SF-36 questionnaire, the lowest average scores were found in the energy/fatigue subscales and in the limitations due to mental health, which remained consistent across surgery types with a significant decrease in the SADI-S group. Concerning the WHOQOL-BREF questionnaire, the lowest mean scores were found in the environment (15.03 ± 2.37) and social relations (16.08 ± 2.22) subscales, whilst the highest average scores were in physical health (16.30 ± 2.03) and mental health (16.57 ± 2.16). Conclusions: the findings revealed that whilst bariatric surgery significantly improved physical health, it resulted in a decrease in mental health scores. Consequently, the study emphasizes the importance of adopting a holistic approach to managing obesity that considers improving both physical and mental health outcomes. Full article
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10 pages, 612 KiB  
Article
Larissa Heart Failure Risk Score and Mode of Death in Acute Heart Failure: Insights from REALITY-AHF
by Andrew Xanthopoulos, Angeliki Bourazana, Yuya Matsue, Yudai Fujimoto, Shogo Oishi, Eiichi Akiyama, Satoshi Suzuki, Masayoshi Yamamoto, Keisuke Kida, Takahiro Okumura, Grigorios Giamouzis, John Skoularigis, Filippos Triposkiadis and Takeshi Kitai
J. Clin. Med. 2023, 12(11), 3722; https://doi.org/10.3390/jcm12113722 - 28 May 2023
Cited by 1 | Viewed by 1795
Abstract
Patients with heart failure (HF) patients may die either suddenly (sudden cardiac death/SCD) or progressively from pump failure. The heightened risk of SCD in patients with HF may expedite important decisions about medications or devices. We used the Larissa Heart Failure Risk Score [...] Read more.
Patients with heart failure (HF) patients may die either suddenly (sudden cardiac death/SCD) or progressively from pump failure. The heightened risk of SCD in patients with HF may expedite important decisions about medications or devices. We used the Larissa Heart Failure Risk Score (LHFRS), a validated risk model for all-cause mortality and HF rehospitalization, to investigate the mode of death in 1363 patients enrolled in the Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure (REALITY-AHF). Cumulative incidence curves were generated using a Fine–Gray competing risk regression, with deaths that were not due to the cause of death of interest as a competing risk. Likewise, the Fine–Gray competing risk regression analysis was used to evaluate the association between each variable and the incidence of each cause of death. The AHEAD score, a well-validated HF risk score ranging from 0 to 5 (atrial fibrillation, anemia, age, renal dysfunction, and diabetes mellitus), was used for the risk adjustment. Patients with LHFRS 2–4 exhibited a significantly higher risk of SCD (HR hazard ratio adjusted for AHEAD score 3.15, 95% confidence interval (CI) (1.30–7.65), p = 0.011) and HF death (adjusted HR for AHEAD score 1.48, 95% CI (1.04–2.09), p = 0.03), compared to those with LHFRS 0,1. Regarding cardiovascular death, patients with higher LHFRS had significantly increased risk compared to those with lower LHFRS (HR 1.44 adjusted for AHEAD score, 95% CI (1.09–1.91), p = 0.01). Lastly, patients with higher LHFRS exhibited a similar risk of non-cardiovascular death compared to those with lower LHFRS (HR 1.44 adjusted for AHEAD score, 95% CI (0.95–2.19), p = 0.087). In conclusion, LHFRS was associated independently with the mode of death in a prospective cohort of hospitalized HF patients. Full article
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12 pages, 1416 KiB  
Article
Validation of the Surgical Outcome Risk Tool (SORT) and SORT v2 for Predicting Postoperative Mortality in Patients with Pancreatic Cancer Undergoing Surgery
by Anna P. Karamolegkou, Maria P. Fergadi, Dimitrios E. Magouliotis, Athina A. Samara, Evangelos Tatsios, Andrew Xanthopoulos, Chryssa Pourzitaki, David Walker and Dimitris Zacharoulis
J. Clin. Med. 2023, 12(6), 2327; https://doi.org/10.3390/jcm12062327 - 16 Mar 2023
Cited by 1 | Viewed by 1205
Abstract
Background: Pancreatic cancer surgery is related to significant mortality, thus necessitating the accurate assessment of perioperative risk to enhance treatment decision making. A Surgical Outcome Risk Tool (SORT) and SORT v2 have been developed to provide enhanced risk stratification. Our aim was to [...] Read more.
Background: Pancreatic cancer surgery is related to significant mortality, thus necessitating the accurate assessment of perioperative risk to enhance treatment decision making. A Surgical Outcome Risk Tool (SORT) and SORT v2 have been developed to provide enhanced risk stratification. Our aim was to validate the accuracy of SORT and SORT v2 in pancreatic cancer surgery. Method: Two hundred and twelve patients were included and underwent pancreatic surgery for cancer. The surgeries were performed by a single surgical team in a single tertiary hospital (2016–2022). We assessed a total of four risk models: SORT, SORT v2, POSSUM (Physiology and Operative Severity Score for the enumeration of Mortality and Morbidity), and P-POSSUM (Portsmouth-POSSUM). The accuracy of the model was evaluated using an observed-to-expected (O:E) ratio and the area under the curve (AUC). Results: The 30-day mortality rate was 3.3% (7 patients). Both SORT and SORT v2 demonstrated excellent discrimination traits (AUC: 0.98 and AUC: 0.98, respectively) and provided the best-performing calibration in the total analysis. However, both tools underestimated the 30-day mortality. Furthermore, both reported a high level of calibration and discrimination in the subgroup of patients undergoing pancreaticoduodenectomy, with previous ERCP, and CA19-9 ≥ 500 U/mL. Conclusions: SORT and SORT v2 are efficient risk-assessment tools that should be adopted in the perioperative pathway, shared decision-making (SDM) process, and counseling of patients with pancreatic cancer undergoing surgery. Full article
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Review

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11 pages, 581 KiB  
Review
Perioperative Fluid Management in Colorectal Surgery: Institutional Approach to Standardized Practice
by Philip Deslarzes, Jonas Jurt, David W. Larson, Catherine Blanc, Martin Hübner and Fabian Grass
J. Clin. Med. 2024, 13(3), 801; https://doi.org/10.3390/jcm13030801 - 30 Jan 2024
Viewed by 828
Abstract
The present review discusses restrictive perioperative fluid protocols within enhanced recovery after surgery (ERAS) pathways. Standardized definitions of a restrictive or liberal fluid regimen are lacking since they depend on conflicting evidence, institutional protocols, and personal preferences. Challenges related to restrictive fluid protocols [...] Read more.
The present review discusses restrictive perioperative fluid protocols within enhanced recovery after surgery (ERAS) pathways. Standardized definitions of a restrictive or liberal fluid regimen are lacking since they depend on conflicting evidence, institutional protocols, and personal preferences. Challenges related to restrictive fluid protocols are related to proper patient selection within standardized ERAS protocols. On the other hand, invasive goal-directed fluid therapy (GDFT) is reserved for more challenging disease presentations and polymorbid and frail patients. While the perfusion rate (mL/kg/h) appears less predictive for postoperative outcomes, the authors identified critical thresholds related to total intravenous fluids and weight gain. These thresholds are discussed within the available evidence. The authors aim to introduce their institutional approach to standardized practice. Full article
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Other

24 pages, 5444 KiB  
Systematic Review
Accuracy of Artificial Intelligence-Based Technologies for the Diagnosis of Atrial Fibrillation: A Systematic Review and Meta-Analysis
by Nikolaos Manetas-Stavrakakis, Ioanna Myrto Sotiropoulou, Themistoklis Paraskevas, Stefania Maneta Stavrakaki, Dimitrios Bampatsias, Andrew Xanthopoulos, Nikolaos Papageorgiou and Alexandros Briasoulis
J. Clin. Med. 2023, 12(20), 6576; https://doi.org/10.3390/jcm12206576 - 17 Oct 2023
Viewed by 1506
Abstract
Atrial fibrillation (AF) is the most common arrhythmia with a high burden of morbidity including impaired quality of life and increased risk of thromboembolism. Early detection and management of AF could prevent thromboembolic events. Artificial intelligence (AI)--based methods in healthcare are developing quickly [...] Read more.
Atrial fibrillation (AF) is the most common arrhythmia with a high burden of morbidity including impaired quality of life and increased risk of thromboembolism. Early detection and management of AF could prevent thromboembolic events. Artificial intelligence (AI)--based methods in healthcare are developing quickly and can be proved as valuable for the detection of atrial fibrillation. In this metanalysis, we aim to review the diagnostic accuracy of AI-based methods for the diagnosis of atrial fibrillation. A predetermined search strategy was applied on four databases, the PubMed on 31 August 2022, the Google Scholar and Cochrane Library on 3 September 2022, and the Embase on 15 October 2022. The identified studies were screened by two independent investigators. Studies assessing the diagnostic accuracy of AI-based devices for the detection of AF in adults against a gold standard were selected. Qualitative and quantitative synthesis to calculate the pooled sensitivity and specificity was performed, and the QUADAS-2 tool was used for the risk of bias and applicability assessment. We screened 14,770 studies, from which 31 were eligible and included. All were diagnostic accuracy studies with case–control or cohort design. The main technologies used were: (a) photoplethysmography (PPG) with pooled sensitivity 95.1% and specificity 96.2%, and (b) single-lead ECG with pooled sensitivity 92.3% and specificity 96.2%. In the PPG group, 0% to 43.2% of the tracings could not be classified using the AI algorithm as AF or not, and in the single-lead ECG group, this figure fluctuated between 0% and 38%. Our analysis showed that AI-based methods for the diagnosis of atrial fibrillation have high sensitivity and specificity for the detection of AF. Further studies should examine whether utilization of these methods could improve clinical outcomes. Full article
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Graphical abstract

18 pages, 3415 KiB  
Systematic Review
Comparative Analysis of Morbidity and Mortality Outcomes in Elderly and Nonelderly Patients Undergoing Elective TEVAR: A Systematic Review and Meta-Analysis
by Angelos Frisiras, Emmanuel Giannas, Stergios Bobotis, Ilektra Kanella, Arian Arjomandi Rad, Alessandro Viviano, Kyriakos Spiliopoulos, Dimitrios E. Magouliotis and Thanos Athanasiou
J. Clin. Med. 2023, 12(15), 5001; https://doi.org/10.3390/jcm12155001 - 29 Jul 2023
Cited by 1 | Viewed by 956
Abstract
Objective: Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating its efficacy and safety in this age cohort is of vital importance. We thus reviewed the existing literature on [...] Read more.
Objective: Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating its efficacy and safety in this age cohort is of vital importance. We thus reviewed the existing literature on this topic to assess the feasibility of TEVAR in elderly patients with severe thoracic aortic pathologies. Methods: We identified all original research studies that assessed TEVAR in elderly patients published up to 2023. Morbidity, as assessed by neurological and respiratory complications, endoleaks, and length of stay, was the primary endpoint. Short-term mortality and long-term survival were the secondary endpoints. The Mantel–Haenszel random and fixed effects methods were used to calculate the odds ratios for each outcome. Further sensitivity and subgroup analyses were performed to validate the outcomes. Results: Twelve original studies that evaluated elective TEVAR outcomes in elderly patients were identified. Seven studies directly compared the use of TEVAR between an older and a younger patient group. Apart from a shorter hospital stay in older patients, no statistically significant difference between the morbidity outcomes of the two different cohorts was found. Short-term mortality and long-term survival results favoured the younger population. Conclusions: The present meta-analysis indicates that, due to a safe perioperative morbidity profile, TEVAR should not be contraindicated in patients based purely on old age. Further research using large patient registries to validate our findings in elderly patients with specific aortic pathologies and both elective and emergency procedures is necessary. Full article
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14 pages, 2798 KiB  
Systematic Review
The Postoperative Effect of Sugammadex versus Acetylcholinesterase Inhibitors in Colorectal Surgery: An Updated Meta-Analysis
by Sascha Vaghiri, Dimitrios Prassas, Sarah Krieg, Wolfram Trudo Knoefel and Andreas Krieg
J. Clin. Med. 2023, 12(9), 3235; https://doi.org/10.3390/jcm12093235 - 30 Apr 2023
Cited by 2 | Viewed by 1436
Abstract
Background: the aim of this meta-analysis was to evaluate the postoperative effects of neuromuscular blockade reversal with sugammadex compared with acetylcholinesterase inhibitors in colorectal surgery. Methods: A systematic literature search was performed for studies comparing the postoperative course of patients receiving neuromuscular blockade [...] Read more.
Background: the aim of this meta-analysis was to evaluate the postoperative effects of neuromuscular blockade reversal with sugammadex compared with acetylcholinesterase inhibitors in colorectal surgery. Methods: A systematic literature search was performed for studies comparing the postoperative course of patients receiving neuromuscular blockade reversal with either sugammadex or acetylcholinesterase inhibitors (control) after colorectal surgery. Data from eligible studies were extracted, qualitatively assessed, and included in a meta-analysis. Odds ratios and standardized mean differences with 95% confidence intervals (CIs) were calculated. Results: Five studies with a total of 1969 patients were included (sugammadex n = 1137, control n = 832). Sugammadex reversal resulted in a significantly faster return of defecation or flatus after surgery compared to acetylcholinesterase inhibitors (SMD 13.01, 95% CI 6.55–19.46, p = < 0.0001). There were no significant differences between the two groups in other clinical outcomes such as surgical morbidity and length of hospital stay. Conclusion: The present data support the beneficial impact of sugammadex on gastrointestinal motility after colorectal surgery. However, the effect of sugammadex on the prevention of surgical complications and a prolonged hospital stay is diminishing. Larger randomized controlled trials with standardized study protocols are needed to validate the results presented here. Full article
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7 pages, 413 KiB  
Brief Report
Is There a High Risk for GI Bleeding Complications in Patients Undergoing Abdominal Surgery?
by Dörte Wichmann, Olena Orlova, Alfred Königsrainer and Markus Quante
J. Clin. Med. 2023, 12(4), 1374; https://doi.org/10.3390/jcm12041374 - 09 Feb 2023
Cited by 1 | Viewed by 1172
Abstract
Introduction: Gastrointestinal bleeding (GIB) can cause life-threatening situations. Here, endoscopy is the first-line diagnostic and therapeutic mode in patients with GIB among further therapeutic approaches such as embolization or medical treatment. Although GIB is considered the most common indication for emergency endoscopy in [...] Read more.
Introduction: Gastrointestinal bleeding (GIB) can cause life-threatening situations. Here, endoscopy is the first-line diagnostic and therapeutic mode in patients with GIB among further therapeutic approaches such as embolization or medical treatment. Although GIB is considered the most common indication for emergency endoscopy in clinical practice, data on GIB in abdominal surgical patients are still scarce. Patients and methods: For the present study, all emergency endoscopies performed on hospitalized abdominal surgical patients over a 2-year period (1 July 2017–30 June2019) were retrospectively analyzed. Primary endpoint was 30-day mortality. Secondary endpoints were length of hospital stay, cause of bleeding, and therapeutic success of endoscopic intervention. Results: During the study period, bleeding events with an indication for emergency endoscopy occurred in 2.0% (129/6455) of all surgical inhouse patients, of whom 83.7% (n = 108) underwent a surgical procedure. In relation to the total number of respective surgical procedures during the study period, the bleeding incidence was 8.9% after hepatobiliary surgery, 7.7% after resections in the upper gastrointestinal tract, and 1.1% after colonic resections. Signs of active or past bleeding in the anastomosis area were detected in ten patients (6.9%). The overall 30-day mortality was 7.75%. Conclusions: The incidence of relevant gastrointestinal bleeding events in visceral surgical inpatients was overall rare. However, our data call for critical peri-operative vigilance for bleeding events and underscore the importance of interdisciplinary emergency algorithms. Full article
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