3 research outputs found
Sympathectomie thoracique dans les hyperhidroses palmoplantaires (étude ouverte à propos de 24 cas)
LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Prospective Evaluation of In-hospital Mortality with the P-POSSUM Scoring System in Patients Undergoing Major Digestive Surgery
Background The P-POSSUM score, the most well known of predictive scores
for postoperative mortality, requires validation for population and
setting.
Methods Validation methods included discrimination (C-index statistic),
observed: expected (O:E) ratio, calibration with the Hosmer-Lemeshow
test, and subgroup analysis (emergency surgery, cancer, age, organs).
The study included 3,881 multisite patients undergoing major digestive
surgery in France.
Results Discrimination via the receiver operating characteristic curve
was good (C-index = 0.87). The overall O: E ratio was 1 (95% confidence
interval ([95 % CI]: 0.88-1.13), and therefore the quality of the
surgical performance is within normal ranges. The O: E ratio, calculated
by risk ranges, showed overestimation in the low risk range, especially
in the 3 % to 6 % and 6 % to 10 % ranges. Calibration was poor (p <
0.001). The model deviated from the normal pattern of calibration, with
mortality lower than expected in the high-risk range. Subgroup analysis
found reasonable to good discrimination of populations (C-index ranging
from 0.78 to 0.93 except for liver surgery [0.67]) while calibration
of individuals remained poor (p < 0.001 to 0.02).
Conclusions Good discrimination, as well as nonsignificant overall O: E
values, makes P-POSSUM a valuable tool when it is used for surgical
audit to compare mortality between populations for major digestive
surgery. Conversely, poor calibration (goodness-of-fit), especially in
subgroup analysis, and underestimation or overestimation of O: E ratios
considerably limits the value of P-POSSUM for prediction of mortality in
individuals. Therefore P-POSSUM should not be used to predict outcomes
for one particular patient
Safety and long-term outcome of a new concept for surgical adhesion-reduction strategies (Prevadh): a prospective, multicenter study.
International audienceBACKGROUND/AIMS: No agent has been consistently effective in preventing formation of peritoneal adhesions and postoperative bowel obstruction after abdominal surgery. The aim of this prospective multicenter study was to assess clinical safety and efficiency of a new adhesion-reduction barrier METHODOLOGY: Between September 2000 and April 2001, Prevadh was used in 78 patients. Operative procedures included 25 hepatic resections, 7 cholecystectomies, 32 colonic resections, 7 protectomies, 3 colostomy or recovery of continuity, 1 gynaecologic surgery and 3 others. Eleven patients were operated on by laparoscopy and 67 by laparotomy. RESULTS: The overall incidence of abscesses and wound complications was 2.4% and 9% respectively. After a mean follow-up of 36 months (range: 4-51 months), no patients experienced adverse events related to the adhesion barrier. Surgical reoperative procedures were performed in 10 patients for unrelated causes and no bowel obstruction occurred within the protected area. CONCLUSIONS: This study confirmed the safety of Prevadh adhesion barrier and suggested that this resorbable barrier might provide prevention from adhesion formation on peritoneal injured surfaces. However, a large randomized controlled trial remains necessary to prove the real effectiveness of adhesion barriers on clinical long-term outcome