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- ArticleAçık Erişim2023Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue
Ubels, Sander; Matthée, Eric; Verstegen, Moniek; Klarenbeek, Bastiaan; Bouwense, Stefan; van Berge Henegouwen, Mark I.; Daams, Freek; Dekker, Jan Willem T.; van Det, Marc J.; van Esser, Stijn
Introduction: Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main contributor to FTR. This study aimed to assess differences in FTR after AL between centers, and to identify factors that explain these differences. Methods: TENTACLE – Esophagus is a multicenter, retrospective cohort study, which included 1509 patients with AL after esophagectomy. Differences in FTR were assessed between low-volume (<20 resections), middle-volume (20–60 resections) and high-volume centers (≥60 resections). Mediation analysis was performed using logistic regression, including possible mediators for FTR: case-mix, hospital resources, leak severity and treatment. Results: FTR after AL was 11.7%. After adjustment for confounders, FTR was lower in high-volume vs. low-volume (OR 0.44, 95%CI 0.2–0.8), but not versus middle-volume centers (OR 0.67, 95%CI 0.5–1.0). After mediation analysis, differences in FTR were found to be explained by lower leak severity, lower secondary ICU readmission rate and higher availability of therapeutic modalities in high-volume centers. No statistically significant direct effect of hospital volume was found: high-volume vs. low-volume 0.86 (95%CI 0.4–1.7), high-volume vs. middle-volume OR 0.86 (95%CI 0.5–1.4). Conclusion: Lower FTR in high-volume compared with low-volume centers was explained by lower leak severity, less secondary ICU readmissions and higher availability of therapeutic modalities. To reduce FTR after AL, future studies should investigate effective strategies to reduce leak severity and prevent secondary ICU readmission.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Global Incidence and Risk Factors Associated with Postoperative Urinary Retention Following Elective Inguinal Hernia Repair: The Retention of Urine after Inguinal Hernia Elective Repair (RETAINER I) Study
Croghan, Stefanie M.; Mohan, Helen M.; Breen, Kieran J.; McGovern, Ruth; Bennett, Kathleen E.; Boland, Michael R.; Elhadi, Muhammed; Elliott, Jessie A.; Fullard, Anna C.; Lonergan, Peter E.
Importance: Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors. Objective: To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR. Design, Setting, and Participants: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR. Exposure: Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia. Main Outcomes and Measures: The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients. Results: In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72). Conclusions: The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies..
RDL Kalıcı Kaydıİncele - CorrectionAçık Erişim2023Erratum to “Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue” [Eur J Surg Oncol 49 (5) (May 2023) 974–982](S074879832300032X)(10.1016/j.ejso.2023.01.010)
Ubels, Sander; Matthée, Eric; Verstegen, Moniek; Klarenbeek, Bastiaan; Bouwense, Stefan; van Berge Henegouwen, Mark I.; Daams, Freek; Dekker, Jan Willem T.; van Det, Marc J.; van Esser, Stijn
The publisher regrets that when the article was published the following collaboration authors from the “TENTACLE – Esophagus collaborative group” appeared incorrectly in the main author list due to a technical error: Writing Committee, Joos Heisterkamp, Fatih Polat, Jeroen Schouten, Pritam Singh, Study collaborators. This has now been corrected. The publisher would like to apologise for any inconvenience caused.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2023Invited Commentary: The Efficacy of VAMMFT Compared to “Bogota Bag” in Achieving Sheath Closure Following Temporary Abdominal Closure at Index Laparotomy for Trauma
Isik, Arda; Memis, Ufuk
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Treatment of anastomotic leak after oesophagectomy for oesophageal cancer: large, collaborative, observational TENTACLE cohort study
Ubels, Sander; Verstegen, Moniek H.P.; Klarenbeek, Bastiaan R.; Bouwense, Stefan; van Berge Henegouwen, Mark I.; Daams, Freek; van Det, Marc J.; Griffiths, Ewen A.; Haveman, Jan Willem; Heisterkamp, Joos
Background: Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy. Methods: A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011-2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confounders. Results: Of 1508 patients with anastomotic leak, 28.2 per cent (425 patients) had local manifestations, 36.3 per cent (548 patients) had intrathoracic manifestations, 9.6 per cent (145 patients) had conduit ischaemia/necrosis, 17.5 per cent (264 patients) were allocated after multiple imputation, and 8.4 per cent (126 patients) were excluded. After propensity score matching, no statistically significant differences in 90-day mortality were found regarding interventional versus supportive-only treatment for local manifestations (risk difference 3.2 per cent, 95 per cent c.i. -1.8 to 8.2 per cent), drainage and defect closure versus drainage only for intrathoracic manifestations (risk difference 5.8 per cent, 95 per cent c.i. -1.2 to 12.8 per cent), and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis (risk difference 0.1 per cent, 95 per cent c.i. -21.4 to 1.6 per cent). In general, less morbidity was found after less extensive primary treatment strategies. Conclusion: Less extensive primary treatment of anastomotic leak was associated with less morbidity. A less extensive primary treatment approach may potentially be considered for anastomotic leak. Future studies are needed to confirm current findings and guide optimal treatment of anastomotic leak after oesophagectomy.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Vascular e-Learning in the MENA Region during the COVID-19 Pandemic
Karam, Lamisse; Patelis, Nikolaos; Matheiken, Sean; Bisdas, Theodosios; Jing, Zaiping; Feng, Jiaxuan; Trenner, Matthias; Ocke Reis, Paulo Eduardo; Elkouri, Stephane; Lecis, Alexandre
Introduction: With the steady rise in interest in e-learning and the sudden boost provoked by the COVID-19 pandemic, it becomes necessary to explore the e-learning experience within the medical community in the MENA region. Methods: An online survey was conducted during the early phase of the COVID-19 pandemic (June 15 - October 15, 2020). Results: Seventy-eight vascular surgeons and trainees from 16 countries participated. 88% of the participants were male. 55% attended more than 4 activities. More than half of the activities did not lead to any official certification. Topic was the primary determinant for attending an activity. National societies and social media played a major role in disseminating activity-related information. Lack of time, increased workload, differences in time zone, and technical issues were the main obstacles cited. 84.7% of the participants had a positive impression. Conclusion: As the COVID-19 pandemic boosted e-learning activities in vascular surgery, a shift was observed in the learning mode and new leadership skills were called upon. Novel ways of quality control are required.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022Factors Associated with the Occurrence and Healing of Umbilical Pilonidal Sinus: A Rare Clinical Entity
Isik, Arda; Wysocki, Arkadiusz Peter; Memiş, Ufuk; Sezgin, Efe; Yezhikova, Assel; Islambekov, Yersultan
Objective: Pilonidal sinus disease (PSD) is a chronic inflammatory condition of skin that is thought to be related to implanted loose hair. Although PSD is most frequently seen in the sacrococcygeal region, it can also occur at the axilla, perineum, suprapubic regions, hands, and umbilicus. The aim of this project was to find factors influencing the development and treatment of umbilical PSD. Methods: In this retrospective study, the authors evaluated 82 patients (19 women, 63 men) with a history of umbilical PSD between 2012 and 2020 to determine predisposing factors and treatment modalities. Results: There was a 20% concordance with intergluteal PSD. Smoking was the only modifying factor for recurrence. The three different treatment methods studied (conservative treatment, surgical treatment, silver nitrate) did not differ in recurrence rate (P =.57). Conclusions: Because of its rare nature, umbilical PSD can be misdiagnosed or underdiagnosed. Key aspects of treatment include smoking cessation and a conservative approach.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score
Ubels, Sander; Verstegen, Moniek H.P.; Klarenbeek, Bastiaan R.; Bouwense, Stefan; van Berge Henegouwen, Mark I.; Daams, Freek; van Det, Marc J.; Griffiths, Ewen A.; Haveman, Jan Willem; Heisterkamp, Joos
Background: Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score. Methods: This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally. Results: Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification. Conclusion: The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit
Podda, Mauro; Pacella, Daniela; Pellino, Gianluca; Coccolini, Federico; Giordano, Alessio; Di Saverio, Salomone; Pata, Francesco; Ielpo, Benedetto; Virdis, Francesco; Damaskos, Dimitrios
Background/objectives: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines. Methods: All consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data. Results: Complete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P < 0.00001), early enteral feeding (33.2%, χ2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P < 0.00001), with wide variability based on the admitting speciality. Conclusions: The results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality. Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990).
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study
Thereska, Dariel; Bollano, Enton; Vrapi, Enxhi; Agastra, Ervis; Dajti, Irida; Kerpaci, Jola; Gjyli, Kostandin; Zijaj, Lorena; Haif, Assia; Djahida, Bahraoui
Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9–2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
RDL Kalıcı Kaydıİncele - DatasetAçık Erişim2021Dataset of the vascular e-Learning during the COVID-19 pandemic (EL-COVID) survey
Patelis, Nikolaos; Bisdas, Theodosios; Jing, Zaiping; Feng, Jiaxuan; Trenner, Matthias; Tri Nugroho, Nyityasmono; Reis, Paulo Eduardo Ocke; Elkouri, Stephane; Lecis, Alexandre; Karam, Lamisse
This dataset supports the findings of the vascular e-Learning during the COVID-19 pandemic survey (the EL-COVID survey). The General Data Protection Regulation (GDPR) of the European Union was taken into consideration in all steps of data handling. The survey was approved by the institutional ethics committee of the Primary Investigator and an online English survey consisting of 18 questions was developed ad-hoc. A bilingual English-Mandarin version of the questionnaire was developed according to the instructions of the Chinese Medical Association in order to be used in mainland People's Republic of China. Differences between the two questionnaires were minor and did affect the process of data collection. Both questionnaires were hosted online. The EL-COVID survey was advertised through major social media. All national and regional contributors contacted their respective colleagues through direct messaging on social media or by email. Eight national societies or groups supported the dissemination of the EL-COVID survey. The data provided demographics information of the EL-COVID participants and an insight on the level of difficulty in accessing or citing previously attended online activities and whether participants were keen on citing these activities in their Curricula Vitae. A categorization of additional comments made by the participants are also based on the data. The survey responses were filtered, anonymized and submitted to descriptive analysis of percentage.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: The COVIDSurg mortality score
Bravo, Laura; Nepogodiev, Dmitri; Glasbey, James C.; Li, Elizabeth; Simoes, Joana F.F.; Kamarajah, Sivesh K.; Picciochi, Maria; Abbott, Tom E.F.; Ademuyiwa, Adesoji O.; Arnaud, Alexis P.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
Nepogodiev, Dmitri; Bhangu, Aneel; Simoes, Joana F.F.; Li, Elizabeth; Picciochi, Maria; Glasbey, James C.; Alser, Osaid; Boccalatte, Luis A.; Duran, Irani; Elhadi, Muhammed
Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021A novel first-line treatment alternative for noncomplicated idiopathic granulomatous mastitis: Combined i˙ntralesional steroid i˙njection with topical steroid administration
Toktas, Osman; Konca, Can; Trabulus, Didem Can; Soyder, Aykut; Koksal, Hande; Karanlik, Hasan; Kamali Polat, Ayfer; Ozbas, Serdar; Yormaz, Serdar; Isik, Arda
Background: Idiopathic granulomatous mastitis (IGM) is a rare form of nonlactational mastitis. Due to the small number of case series and consequently inadequate prospective studies, there is still no consensus on the optimal treatment of IGM. In this study, we aimed to compare the efficacy of intralesional steroid injection with concomitant topical steroids to systemic steroid therapy only in the treatment of noncomplicated IGM. Methods: Between June 2015 and April 2018, the patients' data was prospectively collected and analyzed retrospectively. The study included a total of 78 female patients diagnosed with IGM. Patients were divided into 2 groups: the local steroid treatment group (intralesional steroid injection with topical steroid administration; group 1, n = 46) and the peroral systemic steroid treatment group (group 2, n = 32). Response to the therapy, side effects, recurrence, the need for surgical treatment, and complication rates were compared. Results: Forty-three patients (93.5%) in group 1 achieved a partial or complete response compared to 23 patients (71.9%) in group 2 after 3 months; this difference was significant (p = 0.012). The recurrence rates were significantly lower in group 1 (8.7%) compared to group 2 (46.9%; p = 0.001), and the need for surgical treatment was significantly less in group 1 (2.2%) than in group 2 (9.4%; p = 0.001). While the complication rates were similar between groups, a higher rate of systemic side effects was observed in group 2. Conclusion: Based on the results of our study, combined steroid injection and topical steroid treatment in IGM is as effective as systemic steroid treatment. We suggest that this combination therapy of topical steroids and local steroid injection should be used as first-line therapy in patients with noncomplicated IGM.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021The Effect of Primary Surgery in Patients with De Novo Stage IV Breast Cancer with Bone Metastasis Only (Protocol BOMET MF 14-01): A Multi-Center, Prospective Registry Study
Soran, Atilla; Dogan, Lutfi; Isik, Arda; Ozbas, Serdar; Trabulus, Didem Can; Demirci, Umut; Karanlik, Hasan; Soyder, Aykut; Dag, Ahmet; Bilici, Ahmet
Background: More evidence shows that primary surgery for de novo metastatic breast cancer (BC) prolongs overall survival (OS) in selected cases. The aim of this study was to evaluate the role of locoregional treatment (LRT) in BC patients with de novo stage IV bone only metastasis (BOM). Methods: The prospective, multicenter registry study BOMET MF14-01 was initiated in May 2014. Patients with de novo stage IV BOM BC were divided into two groups: those receiving systemic treatment (ST group) and those receiving LRT (LRT group). Patients who received LRT were further divided into two groups: ST after LRT (LRT + ST group) and ST before LRT (ST + LRT group). Results: We included 505 patients in this study; 240 (47.5%) patients in the ST group and 265 (52.5%) in the LRT group. One hundred and thirteen patients (26.3%) died in the 34-month median follow-up, 85 (35.4%) in the ST group and 28 (10.5%) in LRT group. Local progression was observed in 39 (16.2%) of the patients in the ST group and 18 (6.7%) in the LRT group (p = 0.001). Hazard of death was 60% lower in the LRT group compared with the ST group (HR 0.40, 95% CI 0.30–0.54, p < 0.0001). Conclusion: In this prospectively maintained registry study, we found that LRT prolonged survival and decreased locoregional recurrence in the median 3-year follow-up. Timing of primary breast surgery either at diagnosis or after ST provided a survival benefit similar to ST alone in de novo stage IV BOM BC patients.
RDL Kalıcı Kaydıİncele - LetterAçık Erişim2021Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery
Schache, A.G.; Shaw, Richard; Winter, Stuart C.; Glasbey, James; Ganly, I.; Batstone, M.; Biel, Juan Rey; Simon, Christian; Omar, Omar; Simoes, Joana F.F.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021Vascular e-Learning During the COVID-19 Pandemic: The EL-COVID Survey
Patelis, Nikolaos; Bisdas, Theodosios; Jing, Zaiping; Feng, Jiaxuan; Trenner, Matthias; Tri Nugroho, Nyityasmono; Ocke Reis, Paulo Eduardo; Elkouri, Stephane; Lecis, Alexandre; Karam, Lamisse
Background: The corona virus disease (COVID-19) pandemic has radically changed the possibilities for vascular surgeons and trainees to exchange knowledge and experience. The aim of the present survey is to inventorize the e-learning needs of vascular surgeons and trainees as well as the strengths and weaknesses of vascular e-Learning. Methods: An online survey consisting of 18 questions was created in English, with a separate bilingual English-Mandarin version. The survey was dispersed to vascular surgeons and trainees worldwide through social media and via direct messaging from June 15, 2020 to October 15, 2020. Results: Eight hundred and fifty-six records from 84 different countries could be included. Most participants attended several online activities (>4: n = 461, 54%; 2–4: n = 300, 35%; 1: n = 95, 11%) and evaluated online activities as positive or very positive (84.7%). In deciding upon participation, the topic of the activity was most important (n = 440, 51.4%), followed by the reputation of the presenter or the panel (n = 178, 20.8%), but not necessarily receiving accreditation or certification (n = 52, 6.1%). The survey identified several shortcomings in vascular e-Learning during the pandemic: limited possibility to attend due to lack of time and increased workload (n = 432, 50.5%), no protected/allocated time (n = 488, 57%) and no accreditation or certification, while technical shortcomings were only a minor problem (n = 25, 2.9%). Conclusions: During the COVID-19 pandemic vascular e-Learning has been used frequently and was appreciated by vascular professionals from around the globe. The survey identified strengths and weaknesses in current e-Learning that can be used to further improve online learning in vascular surgery.
RDL Kalıcı Kaydıİncele - LetterAçık Erişim2021Impact of Bacillus Calmette-Gue´rin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 infection
Tabiri, Stephen; Kamarajah, Sivesh K.; Nepogodiev, Dmitri; Li, Elizabeth; Sravanam, Sanskrithi; Owusu, Sheila Agyeiwaa; Mahama, Haruna; Agyeman, Yaa Nyarko; Arthur, Joshua; Kunfah, Sheba Mary
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020The Effect of Ozone Treatment on Thermal Burn Wound Healing; an Experimental Study
Peker, Kemal; Yilmaz, Ismayil; Demiryilmaz, Ismail; Isik, Arda; Sayar, Ilyas; Gursul, Cebrail; Cankaya, Murat; Coban, Taha Abdulkadir
Objective: Ozone has been advised as a metabolic excitative in cell, immunomodulatory agent and antioxidant enzyme actuator. The present study was performed to designate the profit of ozone therapy on the burn wound healing in the rats. Methods: 40 adult Wistar type rats divided into 4 groups: a control group (burn not created and topical and systemic agents not used), a burn group (burn created but only saline given), a burn+silver sulfadiazine group (silver sulfadiazine was applied for 21 days), a burn+ozone/oxygen mixture group (ozone/oxygen mixture was applied for 21 days).After anesthetizing, second-degree burn (2 cm2 areas) was done on the dorsal of the animals byaluminum plate in boiling hot water (100 degrees C for 15 seconds) and other groups except control group were treated topically, based on the time scheduled. Tissue samples were harvested on day 7st and 21st after burn injury. Biochemical and histological analyzes were performed in tissue and blood samples. The results were assessed with appropriate statistical tests and given as Means +/- SD. Results: The histopathologic damage level was significantly different in all groups. Fibrosis and inflamation levels decreased in ozone treatment and silver sulphadiazine groups compared to burn+normal saline group on the 21 days according to 7 days. In the ozone treatment group, Glucose 6-phosphate dehydrogenase activities were significantly higher than the silver sulfadiazine treated group. But glutathione reductase enzyme activities were lover in the ozone treated group and hydroxyproline concentration decreased in ozone group compared to burn+normal saline group on 7 and 21 days. Conclusions: Ozone has a detractive effect in the development of inflamation, fibrosis, and granulation via decreasing tissue damage and increasing the antioxidant enzyme activity on burn wound healing.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2020Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen
Ceresoli, Marco; Negoi, Ionut; Zese, Monica; Occhionorelli, Savino; Gubbiotti, Francesca; Shlyapnikov, Sergei; Galatioto, Christian; Chiarugi, Massimo; Demetrashvili, Zaza; Dondossola, Daniele
Background: Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. Methods: This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30 kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero-atmospheric fistula rate and length of ICU stay. Results: A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5 days vs. 6.3 ± 7.5 days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p < 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson’s linear correlation coefficient = 0,201; p < 0,001). Conclusions: Open abdomen in obese patients seems to be safe as in non-obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. Trial registration number: ClinicalTrials.gov, Identifier: NCT02382770.
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