Materials and Methods: Family members of 60 patients (one for each patient) who were undergoing major oncological surgery lasting more than 1 h were recruited and randomized into two groups (30 patients each). Group 1 (no SMS group) did not receive any text message while Group 2 (SMS group) received periodic intraoperative text messages. Respondents aged less than 16 years, those with associated psychiatric illnesses, and those who did not consent to the study were excluded. Anxiety among family members was assessed using the Visual Analogue Scale for Anxiety (VAS-A) and Anxiety component of Hospital Anxiety and Depression Scale (HADS-A) at five different periods; (P1) 1 day prior to surgery (P2) at separation from family at the operation theatre (P3) 1 h after commencement of surgery (P4) immediately after completion of surgery, and (P5) 1 day after surgery.
Results: The mean VAS-A and HADS-S scores between both the groups did not show a statistically significant difference for P1, P2 and P5 assessment periods (preoperative period, separation in operation theatre, post-operative period). However, mean VAS-A and HADS-A scores were significantly higher for Group 1 compared to Group 2 during P3 and P4 periods, 1 h after commencement of surgery and completion of surgery, respectively.
Conclusion: Periodic text messages updating the status of ongoing surgery helps to reduce anxiety for family members of patients undergoing oncological surgery during the intraoperative period.
METHODS: In total, 311 patients underwent erect whole spine anteroposterior, lateral and lower limb axis films. Radiographic measurements included Transilium Pelvic Height Difference (TPHD; mm), Hip Abduction-Adduction angle (H/Abd-Add; °), Lower limb Length Discrepancy (LLD; mm), and Pelvic Hypoplasia (PH angle; °). The incidence and severity of pelvic obliquity were stratified to Lenke curve subtypes in 311 patients. The causes of pelvic obliquity were analyzed in 57 patients with TPHD ≥10 mm.
RESULTS: The mean Cobb angle was 64.0 ± 17.2°. Sixty-nine patients had a TPHD of 0 mm (22.2%). The TPHD was <5 mm in 134 (43.0%) patients, 5-9 mm in 104 (33.4%) patients, 10-14 mm in 52 (16.7%) patients, 15-19 mm in 19 (6.1%) patients, and ≥20 mm in only 2 (0.6%) patients. There was a significant difference between the Lenke curve types in terms of TPHD (p = 0.002). L6 curve types had the highest TPHD of 9.0 ± 6.3 mm followed by L5 curves, which had a TPHD of 7.1 ± 4.8 mm. In all, 44.2% of L1 curves and 50.0% of L2 curves had positive TPHD compared to 66.7% of L5 curves and 74.1% of L6 curves which had negative TPHD. 33.3% and 24.6% of pelvic obliquity were attributed to PH and LLD, respectively, whereas 10.5% of cases were attributed to H/Abd-Add positioning.
CONCLUSIONS: 76.4% of AIS cases had pelvic obliquity <10 mm; 44.2% of L1 curves and 50.0% of L2 curves had a lower right hemipelvis compared to 66.7% of L5 curves and 74.1% of L6 curves, which had a higher right hemipelvis. Among patients with pelvic obliquity ≥10 mm, 33.3% were attributed to PH, whereas 24.6% were attributed to LLD.
METHODS: A total of 142 patients from the Orthopaedics Oncology Database were included into this retrospective study. Kaplan-Meier curve and multivariate Cox proportional models were used to calculate the overall survival of patients with sarcoma who underwent radical excision surgery.
RESULTS: High preoperative LMR is significantly associated with better overall survival and prognosis in sarcoma patients, whereas high preoperative NLR is significantly associated with shorter overall survival and poorer prognosis. Multivariate analysis shows that LMR and NLR are good predictors for overall survival at 3 and 5 years after surgery, respectively. Patients with high preoperative lymphocytes count are associated with longer overall survival, but this association is not statistically significant. Our findings suggest that preoperative NLR and LMR are good predictive markers for survival of sarcoma patients.
CONCLUSION: LMR and NLR can be used to identify patients at risk for poor clinical outcome, so that a more aggressive course of treatment can be applied to improve outcome. These are cost-effective prognostic tools as they are calculated from routine preoperative peripheral blood counts. In conclusion, preoperative NLR and LMR are good prognostic markers for predicting the clinical outcome of patients with sarcoma.
Objective: To determine whether preoperative NT-proBNP has additional predictive value beyond a clinical risk score for the composite of vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days after surgery.
Design: Prospective cohort study.
Setting: 16 hospitals in 9 countries.
Patients: 10 402 patients aged 45 years or older having inpatient noncardiac surgery.
Measurements: All patients had NT-proBNP levels measured before surgery and troponin T levels measured daily for up to 3 days after surgery.
Results: In multivariable analyses, compared with preoperative NT-proBNP values less than 100 pg/mL (the reference group), those of 100 to less than 200 pg/mL, 200 to less than 1500 pg/mL, and 1500 pg/mL or greater were associated with adjusted hazard ratios of 2.27 (95% CI, 1.90 to 2.70), 3.63 (CI, 3.13 to 4.21), and 5.82 (CI, 4.81 to 7.05) and corresponding incidences of the primary outcome of 12.3% (226 of 1843), 20.8% (542 of 2608), and 37.5% (223 of 595), respectively. Adding NT-proBNP thresholds to clinical stratification (that is, the Revised Cardiac Risk Index [RCRI]) resulted in a net absolute reclassification improvement of 258 per 1000 patients. Preoperative NT-proBNP values were also statistically significantly associated with 30-day all-cause mortality (less than 100 pg/mL [incidence, 0.3%], 100 to less than 200 pg/mL [incidence, 0.7%], 200 to less than 1500 pg/mL [incidence, 1.4%], and 1500 pg/mL or greater [incidence, 4.0%]).
Limitation: External validation of the identified NT-proBNP thresholds in other cohorts would reinforce our findings.
Conclusion: Preoperative NT-proBNP is strongly associated with vascular death and MINS within 30 days after noncardiac surgery and improves cardiac risk prediction in addition to the RCRI.
Primary Funding Source: Canadian Institutes of Health Research.
MATERIALS AND METHODS: Records of 688 women between January 2004 and July 2017 were retrospectively reviewed. Patients received urodynamic studies, 1-hour pad test, Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7, and were divided into normal weight, overweight and obese. Objective cure at 1 year was defined as no involuntary urine leakage during filling cystometry and pad test less than 2 gm. Subjective cure was established by negative response to question 3 on Urogenital Distress Inventory-6. McNemar's test, chi-square test, Mann-Whitney U and Fisher's exact test were used for paired categorical variables. Independent samples t-tests and paired t-test were used for continuous parametric variables. Multivariate logistic regression was used to identify risk factors for failure.
RESULTS: Objective and subjective cure in normal, overweight and obese patients was 91.4% and 89.1%, 87.5% and 86%, and 76% and 70.1%, respectively. There was no difference in surgical complications. Obese patients had worse quality of life scores preoperatively and postoperatively. Risk factors in obese patients with failed mid urethral sling included 66 years old or older (OR 2.02, 1.56-3.98), menopause (OR 4.21, 1.21-14.22), previous prolapse surgery (OR 4.57, 2.36-8.52), diabetes (OR 2.79, 1.61-5.99) and intrinsic sphincter deficiency (OR 5.06, 3.08-9.64).
CONCLUSIONS: Obese women with mid urethral sling had lower objective and subjective cure at 1 year and worse quality of life scores compared to normal and overweight women. Risk factors for failure include age, diabetes, menopause, previous prolapse surgery and intrinsic sphincter deficiency.
METHODS: A review of medical records of children who underwent adenotonsillectomy between January 2011 and December 2014 was performed. Association between demographic variables and post-operative complications were examined using chi-square and Mann-Whitney tests.
RESULTS: A total of 214 children were identified, and of these, 19 (8.8%) experienced post-operative complications. Six children (2.8%) had respiratory complications: hypoxaemia in four and laryngospasm requiring reintubation in a further two. Both of the latter patients were extubated upon arrival to PICU and required no escalation of therapy. A total of 13 (6.1%) children had non-respiratory complications: 8 (3.7%) had infection and 5 (2.3%) had haemorrhage. A total of 26 (12.1%) children were electively admitted to PICU and mean stay was 19.5 (SD ± 13) h. No association between demographic characteristics, comorbid conditions or polysomnographic parameters and post-operative complications were noted. A total of 194 (90.7%) children stayed only one night in hospital (median 1 day, range 1-5 days).
CONCLUSION: The previously identified risk factors and criteria for PICU admission need revision, and new recommendations are necessary.