Clinical outcomes of surgically corrected atrial septal defects

Objective: To examine the outcomes of surgical repair of atrial septal defects in paediatric and adult patients. Methods: The retrospective study comprised data of 84 patients who had undergone surgical correction of atrial septal defect at the Aga Khan University Hospital, Karachi, between June 2006 and December 2011. All patients with isolated atrial septal defect (ostium secundum, ostium primum and sinus venosus with or without partial anomalous pulmonary venous connection) were included. Clinical and transthoracic echocardiographic data was reviewed. SPSS 17 was used for statistical analysis. Results: There were no deaths in the study population. The mean time for follow-up was 6.5±9.9 months. Most of the patients (n=80; 95.2%) were in New York Heart Association class I at follow-up, while the remaining 4(4.8%) were in New York Heart Association class II. Post-operatively, 8 (9.5%) patients developed brief episodes of arrhythmias. There were 3 (3.57%) patients who were re-admitted within 30 days; 2 (66.7%) had superficial wound infection, while 1 (33.3%) had to be re-opened because of cardiac tamponade. Conclusion: Surgical repair of atrial septal defects is a safe procedure which is associated with excellent results and low morbidity

Transcatheter versus surgical closure of atrial septum defect: a debate from a developing country

Abstract INTRODUCTION: This study compares the effectiveness and cost of trans-catheter verses surgical closure of secundum atrial septumdefect (ASD). ASD accounts for 10% of congenital cardiac defects. Trans-catheter closure of secundum ASD is increasingly used as the primary intervention. Surgical repair is advised in a proportion of secundum type defects which are unsuitable for device closure. METHODS: We reviewed the clinical course of 176 patients who underwent closure of isolated secundum ASD. The patients were assigned to either the device or surgical group depending upon the treatment they received. Successful closure was assessed immediately after the procedure. The following outcomes were studied: mortality, morbidity, hospital stay, and costs. RESULTS: Ninety five patients were in the surgical group and 81 patients were in the group undergoing device closure. The median age was 14.0 years (range 1.1-61.0) for surgical group and 24.0 years (range 0.5-68.0) for the device group. The mortality in both groups was 0. The procedure success rate was 100% for the surgical group and 96.3% for the device group. The complication rate was 13.7% for surgical group and 7.4% for the device group. The mean length of hospital stay was 5.0 ± 2.7 days for surgical group and 3.0 ± 0.4 days for device group. The procedure cost for surgery was found to be 12.3% lower than that of trans-catheter closure. CONCLUSION: Successful closure is achieved by both methods. Trans-catheter closure results in lower rate of complication and hospital stay but the cost of the procedure tends to be higher than surgery

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Transcatheter Versus Surgical Closure of Atrial Septum Defect: A Debate from a Developing Country

Introduction: This study compares the effectiveness and cost of trans-catheter verses surgicalclosure of secundum atrial septum defect (ASD). ASD accounts for 10% of congenital cardiacdefects. Trans-catheter closure of secundum ASD is increasingly used as the primary intervention.Surgical repair is advised in a proportion of secundum type defects which are unsuitable fordevice closure.Methods: We reviewed the clinical course of 176 patients who underwent closure of isolatedsecundum ASD. The patients were assigned to either the device or surgical group depending uponthe treatment they received. Successful closure was assessed immediately after the procedure. Thefollowing outcomes were studied: mortality, morbidity, hospital stay, and costs.Results: Ninety five patients were in the surgical group and 81 patients were in the groupundergoing device closure. The median age was 14.0 years (range 1.1-61.0) for surgical groupand 24.0 years (range 0.5-68.0) for the device group. The mortality in both groups was 0. Theprocedure success rate was 100% for the surgical group and 96.3% for the device group. Thecomplication rate was 13.7% for surgical group and 7.4% for the device group. The mean lengthof hospital stay was 5.0 ± 2.7 days for surgical group and 3.0 ± 0.4 days for device group. Theprocedure cost for surgery was found to be 12.3% lower than that of trans-catheter closure.Conclusion: Successful closure is achieved by both methods. Trans-catheter closure results inlower rate of complication and hospital stay but the cost of the procedure tends to be higherthan surgery

Bioresorbable antibacterial PCL-PLA-nHA composite membranes for oral and maxillofacial defects

Degradable implant membranes designed to separate hard and soft tissues and to trigger the growth of underlying bone and with antimicrobial properties are needed for the management of bone defects, ridge augmentation and to facilitate dental implants. In this study, the composite scaffolds of poly(lactic acid) (PLA), poly(caprolactone) (PCL) blended with nano hydroxyapatite and cefixime‐β cyclodextrin (Cfx‐βCD) inclusion complexes were synthesized by electrospinning. The prepared electrospun fibrous membranes were characterized by scanning electron microscopy and Fourier transform infrared (FTIR) spectroscopy. Membranes were microporous with random fibers in the range of 0.2–0.37 µm. The data from FTIR spectral analysis helped to characterize the presence of PCL, PLA, Cfx, and βCD in the electrospun membranes. In addition, the mechanical properties (i.e., elastic modulus and tensile strength) of the scaffolds were investigated. The mechanical strength and suture retention ability of the membranes was comparable to that of skin grafts. Drug release assays confirmed the slow release of Cfx from the membranes in the presence of βCD and antimicrobial studies showed that the membranes possessed antibacterial properties. The interaction of cells with membranes was evaluated by culturing them with the mouse pre‐osteoblast cell line MC3T3 and assessment of bone formation was done using Alizarin Red Assay. Culturing MC3T3 cells on the scaffolds showed that cells attached and entered the membranes and increased in number over time. In summary, these membranes are flexible, strong, bactericidal and osteogenic, which are the ideal implant properties for dental and maxillofacial surgery

sj-pdf-1-vmj-10.1177_1358863X241228540 – Supplemental material for Impact of comorbid opioid use disorder and major depressive disorder on healthcare utilization outcomes in patients with peripheral artery disease: A National Readmission Database analysis

Supplemental material, sj-pdf-1-vmj-10.1177_1358863X241228540 for Impact of comorbid opioid use disorder and major depressive disorder on healthcare utilization outcomes in patients with peripheral artery disease: A National Readmission Database analysis by Kelvin Amenyedor, Megan Lee, Miguel Algara, Waleed Tariq Siddiqui, Madeleine Hardt, Gaëlle Romain, Carlos Mena-Hurtado and Kim G Smolderen in Vascular Medicine</p