Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

BackgroundThere is no published data regarding the relationship between hospital volume and outcomes in patients undergoing laparoscopic diaphragmatic hernia repair. We hypothesize that hospitals performing high case volume have improved outcomes compared to low-volume hospitals.Materials and methodsWe reviewed the National Inpatient Sample (NIS) database between 2008 and 2012 for adults with the diagnosis of diaphragmatic hernia who underwent elective laparoscopic repair of diaphragmatic Hernia and/or Nissen fundoplication. Pediatric, emergent, and open cases were excluded. Main outcome measures included logistic regression analysis of factors predictive of in-hospital mortality and outcomes according to annual hospital case volume.ResultsA total of 31,228 laparoscopic diaphragmatic hernia operations were analyzed. The overall in-hospital mortality was 0.14%. Risk factors for higher in-hospital mortality included renal failure (AOR: 6.26; 95% CI: 2.48-15.78; p < 0.001), age>60 years (AOR: 5.06; 95% CI: 2.38-10.76; p < 0.001), and CHF (AOR: 3.80; 95% CI: 1.39-10.38; p = 0.009) while an incremental increase in volume of 10 cases/year (AOR: 0.89; 95% CI: 0.81-0.98; p = 0.019) and diabetes (AOR: 0.34; 95% CI: 0.12-0.93; p = 0.036) decreases mortality. There was a small but significant inverse relationship between hospital case volume and mortality with a 10% reduction in adjusted odds of in-hospital mortality for every increase in 10 cases per year. Using 10 cases per year as the volume threshold, low-volume hospitals (≤10 cases/year) had almost a twofold higher mortality compared to high-volume hospitals (0.23 vs. 0.12%, respectively, p = 0.02).ConclusionsThere was a small but significant inverse relationship between the hospitals' case volume and mortality in laparoscopic diaphragmatic hernia repair

Near-infrared spectroscopy-derived tissue oxygen saturation in battlefield injuries: a case series report

BACKGROUND: Near-infrared spectroscopy technology has been utilized to monitor perfusion status in animal models of hemorrhagic shock and in human traumatic injury. To observe the effectiveness of such a device in a combat setting, an FDA-approved device was used in conjunction with standard resuscitation and therapy of wounded patients presenting to the 228(th )Combat Support Hospital (CSH), Company B, over a three-month period. MATERIALS AND METHODS: These observations were performed on patients presenting to the 228(th )CSH, Co B, at Forward Operating Base Speicher, outside of Tikrit, Iraq, between the dates of June 15 and September 11, 2005. We utilized the Inspectra™ 325 tissue oxygen saturation (StO(2)) monitor (Hutchinson Technology, Inc; Hutchinson, MN, USA) with the probe placed on the thenar eminence or on another appropriate muscle bed, and used to monitor StO(2 )during early resuscitation and stabilization of patients. RESULTS: During the above time period, 161 patients were evaluated at the CSH as a result of traumatic injury and the device was placed on approximately 40 patients. In most patients, StO(2 )readings of greater than 70% were noted during the initial evaluation. No further information was collected from these patients. In 8 patients, convenience samples of StO(2 )data were collected along with pertinent physiologic data. In these patients, StO(2 )levels of below 70% tracked with hypotension, tachycardia, and clinical shock resulted in increases in StO(2 )after resuscitation maneuvers. CONCLUSION: Near-infrared spectroscopy-derived StO(2 )reflected and tracked the resuscitation status of our patients with battlefield injuries. StO(2 )has significant potential for use in resuscitation and care of patients with battlefield injuries

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair.

BackgroundThere is no published data regarding the relationship between hospital volume and outcomes in patients undergoing laparoscopic diaphragmatic hernia repair. We hypothesize that hospitals performing high case volume have improved outcomes compared to low-volume hospitals.Materials and methodsWe reviewed the National Inpatient Sample (NIS) database between 2008 and 2012 for adults with the diagnosis of diaphragmatic hernia who underwent elective laparoscopic repair of diaphragmatic Hernia and/or Nissen fundoplication. Pediatric, emergent, and open cases were excluded. Main outcome measures included logistic regression analysis of factors predictive of in-hospital mortality and outcomes according to annual hospital case volume.ResultsA total of 31,228 laparoscopic diaphragmatic hernia operations were analyzed. The overall in-hospital mortality was 0.14%. Risk factors for higher in-hospital mortality included renal failure (AOR: 6.26; 95% CI: 2.48-15.78; p < 0.001), age>60 years (AOR: 5.06; 95% CI: 2.38-10.76; p < 0.001), and CHF (AOR: 3.80; 95% CI: 1.39-10.38; p = 0.009) while an incremental increase in volume of 10 cases/year (AOR: 0.89; 95% CI: 0.81-0.98; p = 0.019) and diabetes (AOR: 0.34; 95% CI: 0.12-0.93; p = 0.036) decreases mortality. There was a small but significant inverse relationship between hospital case volume and mortality with a 10% reduction in adjusted odds of in-hospital mortality for every increase in 10 cases per year. Using 10 cases per year as the volume threshold, low-volume hospitals (≤10 cases/year) had almost a twofold higher mortality compared to high-volume hospitals (0.23 vs. 0.12%, respectively, p = 0.02).ConclusionsThere was a small but significant inverse relationship between the hospitals' case volume and mortality in laparoscopic diaphragmatic hernia repair

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair.

BackgroundThere is no published data regarding the relationship between hospital volume and outcomes in patients undergoing laparoscopic diaphragmatic hernia repair. We hypothesize that hospitals performing high case volume have improved outcomes compared to low-volume hospitals.Materials and methodsWe reviewed the National Inpatient Sample (NIS) database between 2008 and 2012 for adults with the diagnosis of diaphragmatic hernia who underwent elective laparoscopic repair of diaphragmatic Hernia and/or Nissen fundoplication. Pediatric, emergent, and open cases were excluded. Main outcome measures included logistic regression analysis of factors predictive of in-hospital mortality and outcomes according to annual hospital case volume.ResultsA total of 31,228 laparoscopic diaphragmatic hernia operations were analyzed. The overall in-hospital mortality was 0.14%. Risk factors for higher in-hospital mortality included renal failure (AOR: 6.26; 95% CI: 2.48-15.78; p < 0.001), age>60 years (AOR: 5.06; 95% CI: 2.38-10.76; p < 0.001), and CHF (AOR: 3.80; 95% CI: 1.39-10.38; p = 0.009) while an incremental increase in volume of 10 cases/year (AOR: 0.89; 95% CI: 0.81-0.98; p = 0.019) and diabetes (AOR: 0.34; 95% CI: 0.12-0.93; p = 0.036) decreases mortality. There was a small but significant inverse relationship between hospital case volume and mortality with a 10% reduction in adjusted odds of in-hospital mortality for every increase in 10 cases per year. Using 10 cases per year as the volume threshold, low-volume hospitals (≤10 cases/year) had almost a twofold higher mortality compared to high-volume hospitals (0.23 vs. 0.12%, respectively, p = 0.02).ConclusionsThere was a small but significant inverse relationship between the hospitals' case volume and mortality in laparoscopic diaphragmatic hernia repair

Impact of chronic steroid use on outcomes of colorectal surgery.

BackgroundSteroid use has been recognized as a factor which has various effects on multiple organs. We aim to investigate the association between chronic steroid use and postoperative complications after colorectal surgery.MethodsThe National Surgical Quality Improvement Program database was used to examine the clinical data of patients undergoing colorectal resection during 2005 to 2013. Multivariate regression analysis was performed to investigate outcomes of patients with chronic steroid use.ResultsWe sampled a total of 147,121 patients who underwent colorectal resection. Of these, 11,195 (7.6%) had a history of chronic steroid use. Patients who had chronic steroid use had a higher risk of preoperative sepsis (adjusted odds ratio [AOR]: 1.41, P < .01), hypoalbuminemia (AOR: 1.49, P < .01), bleeding disorders (AOR: 1.54, P < .01), and diabetes (AOR: 1.11, P = .01). Chronic steroid use was associated with a significant increase in the mortality and morbidity of patients (AOR: 1.56 and 1.25, respectively, P < .01).ConclusionsPatients with a chronic steroid use have a high risk of preoperative malnutrition, diabetes, bleeding disorders, and sepsis. A history of chronic steroid use was associated with a significant increase in the mortality and morbidity of patients

Impact of chronic steroid use on outcomes of colorectal surgery.

BackgroundSteroid use has been recognized as a factor which has various effects on multiple organs. We aim to investigate the association between chronic steroid use and postoperative complications after colorectal surgery.MethodsThe National Surgical Quality Improvement Program database was used to examine the clinical data of patients undergoing colorectal resection during 2005 to 2013. Multivariate regression analysis was performed to investigate outcomes of patients with chronic steroid use.ResultsWe sampled a total of 147,121 patients who underwent colorectal resection. Of these, 11,195 (7.6%) had a history of chronic steroid use. Patients who had chronic steroid use had a higher risk of preoperative sepsis (adjusted odds ratio [AOR]: 1.41, P < .01), hypoalbuminemia (AOR: 1.49, P < .01), bleeding disorders (AOR: 1.54, P < .01), and diabetes (AOR: 1.11, P = .01). Chronic steroid use was associated with a significant increase in the mortality and morbidity of patients (AOR: 1.56 and 1.25, respectively, P < .01).ConclusionsPatients with a chronic steroid use have a high risk of preoperative malnutrition, diabetes, bleeding disorders, and sepsis. A history of chronic steroid use was associated with a significant increase in the mortality and morbidity of patients

Medicina de Urgencias Tomo 1

Public health represents one of the greatest challenges in society, which is why it is essential to strengthen the links of scientific cooperation between the academy and the community under a common premise: guarantee the health of the population. In Ecuador, public health faces a historical challenge framed by two edges: the health crisis due to the Covid-19 pandemic and the shortcomings of the social system. This leads to thinking about both the importance of the problem and its possible solutions. Despite this, it is undeniable to affirm that all health personnel share a common ideology and the same commitment, guaranteeing the health of the population.Obviously it is not an easy task due to social uncertainty and the possible appearance of new diseases; however, it is based on a common denominator: basing decisions on the available scientific evidence or what is known as evidence-based medicine. The generation of new knowledge and the use of the best available scientific evidence is the only hope for solving the health problems that afflict the population. In this way, Emergency Medicine seeks to be a timely and practical clinical-therapeutic reference point for emerging regional circumstances, using updated international management guidelines as references and emphasizing evidence-based medicine. We are sure that it will be an invaluable contribution for health professionals.Emergency Medicine, in its two volumes, is a work carried out by teachers, students and medical and related specialists, from the Medicine and Nursing career of the Catholic University of Cuenca, Azogues Campus. In addition, it has the contribution of other medical specialists with extensive professional experience and contributes with 52 chapters that address clinical, surgical, pediatric, and gynecological-obstetric pathologies that require timely management in the emergency room. At the same time, this work addresses topics of current interest such as medicolegal aspects of emergency care, urgent complications in HIV infections, use of antimicrobials in emergencies, dose adjustment in patients with kidney failure; and, a special chapter on SARS-CoV-2: diagnostic-therapeutic management.La salud pública representa uno de los retos más grandes en la sociedad, razón por lo cual es fundamental que se robustezcan los vínculos de cooperación científica entre la academia y la colectividad bajo una premisa común: garantizar la salud de la población. En Ecuador, la salud pública afronta un reto histórico enmarcado en dos aristas: la crisis sanitaria debido a la pandemia por Covid-19 y las carencias del sistema social. Esto conduce a pensar tanto en la trascendencia del problema como en sus posibles soluciones. A pesar de aquello, resulta innegable afirmar que todo el personal sanitario comparte una ideología en común y el mismo compromiso, garantizar la salud de la población. Evidentemente no constituye una tarea fácil debido a la incertidumbre social y a la posible aparición de nuevas enfermedades; sin embargo, se basa en un denominador común: asentar las decisiones en la evidencia científica disponible o lo que se conoce como medicina basada en la evidencia. La generación de nuevo conocimiento y la utilización de la mejor evidencia científica disponible constituye la única esperanza para resolver los problemas de salud que aquejan a la población. De esta forma, Medicina de Urgencias busca ser un referente clínico- terapéutico, oportuno y práctico, de las circunstancias emergentes regionales, tomando como referencias guías de manejo internacionales actualizadas y haciendo hincapié en la medicina basada en la evidencia. Estamos seguros que será un aporte de carácter invaluable para los profesionales de la salud. Medicina de urgencias, en sus dos volúmenes, es una obra realizada por docentes, estudiantes y especialistas médicos y afines, de la carrera de Medicina y Enfermería de la Universidad Católica de Cuenca, Sede Azogues. Además, cuenta con el aporte de otros médicos especialistas con amplia trayectoria profesional y aporta con 52 capítulos que abordan patologías clínicas, quirúrgicas, pediátricas, y gíneco-obstétricas, que requieren manejo oportuno en la sala de emergencias.  Al mismo tiempo, la presente obra aborda temáticas de interés actual como aspectos médico legales de la atención en urgencias, complicaciones urgentes en las infecciones por VIH, uso de antimicrobianos en emergencias, ajuste de dosis en pacientes con insuficiencia renal; y, un capítulo especial sobre el SARS-CoV-2: manejo diagnóstico-terapéutico