The purpose of this study was to identify patient, clinical, and surgical factors that may predispose patients to anastomotic leak (AL) after large bowel surgery.Anastomotic leak is still one of the most devastating complications following colorectal surgery. Knowledge about factors predisposing patients to AL is vital to its early detection, decision making for surgical time, managing preoperative risk factors, and postoperative complications.This was a prospective observational, quality improvement study in a cohort of 616 patients undergoing colorectal resection in a single institution with the main outcome being AL within 30 days postoperatively. Some of the predictor variables were age, sex, Charlson Comorbidity Index (CCI), radiation and chemotherapy, immunomodulator medications, albumin, preoperative diagnoses, surgical procedure(s), surgical technique (laparoscopic vs open), anastomotic technique (staple vs handsewn), number of major arteries ligated at surgery, surgeon's experience, presence of infectious condition at surgery, intraoperative adverse events, and functional status using 36-Item Short Form General Health Survey.Of the 616 patients, 53.4% were female. The median age of the patients was 63 years and the mean body mass index was 25.9 kg/m. Of them, 80.3% patients had laparoscopic surgery and 19.5% had open surgery. AL occurred in 5.7% (35) patients. In multivariate analysis, significant independent predictors for leak were anastomoses less than 10 cm from the anal verge, CCI of 3 or more, high inferior mesenteric artery ligation (above left colic artery), intraoperative complications, and being of the male sex.Multiple risk factors exist that predispose patients to ALs. These risk factors should be considered before and during the surgical care of colorectal patients.
Study Design: Retrospective study of prospective collected data. Objective: To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis. Summary of Background Data: IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed. Methods: We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis. Results: A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62–72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12–2.60), P =0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04–3.76), P =0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02–1.35), P =0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery. Conclusion: Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.
Study Design. Retrospective review of a prospective cohort study Objective. To identify the association between Oswestry Disability Index (ODI) subsections and overall improvement 2 years after lumbar surgery for degenerative lumbar spondylolisthesis (DLS). Background. DLS often necessitates lumbar surgery. The ODI is a trusted measure for patient-reported outcomes (PROMs) in assessing spinal disorder outcomes. Surgeons utilize the ODI for baseline functional assessment and post-surgery progress tracking. However, it remains uncertain if and how each subsection influences overall ODI improvement. Methods. This retrospective cohort study analyzed patients who underwent lumbar surgery for DLS between 2016 and 2018. Preoperative and 2-year postoperative ODI assessments were conducted. The study analyzed postoperative subsection scores and defined ODI improvement as ODIpreop-ODIpostop >0. Univariate linear regression was applied, and receiver operating characteristic (ROC) analysis determined cut-offs for subsection changes and postoperative target values to achieve overall ODI improvement. Results. 265 patients (60% female, mean age 67±8 y) with a baseline ODI of 50±6 and a postoperative ODI of 20±7 were included. ODI improvement was noted in 91% (242 patients). Achieving a postoperative target score of ≤2 in subsections correlated with overall ODI improvement. Walking had the highest predictive value for overall ODI improvement (AUC 0.91, sensitivity 79%, specificity 91%). Pain intensity (AUC 0.90, sensitivity 86%, specificity 83%) and changing degree of pain (AUC 0.87, sensitivity 86%, specificity 74%) were also highly predictive. Sleeping had the lowest predictability (AUC 0.79, sensitivity 84%, specificity 65%). Except for sleeping, all subsections had a Youden-index >50%. Conclusion. These findings demonstrate how the different ODI subsections associate with overall improvement post-lumbar surgery for DLS. This understanding is crucial for refining preoperative education, addressing particular disabilities, and evaluating surgical efficacy. Additionally, it shows that surgical treatment does not affect all subsections equally.
Background Patients undergo lumbar surgery because they expect improvement in physical and psychological symptoms. Patients and surgeons need to share an understanding of what are possible, probable and realistic expectations so they can work toward the same goals. The objective of this study was to compare concordance (agreement) within the patient-surgeon pair regarding expectations of lumbar surgery. A cross-sectional study of 184 patients scheduled for lumbar surgery and their surgeons performed at a tertiary spine center Methods Patients scheduled for lumbar surgery were recruited from the practices of 5 spine surgeons and interviewed in person several days before surgery with several patient-centered questionnaires including the modified Oswestry Disability Index (ODI) (score range 0–100, higher is worse), the Geriatric Depression Scale (score range 0–30, ≥11 is a positive screen for depression) and the valid Lumbar Spine Surgery Expectations Survey. The 20-item Expectation Survey addresses symptoms, physical function, and psychological well-being, and asks how much improvement is expected with response options of “complete” (=4 points), “a lot” (=3 points), “a moderate amount” (=2 points), “a little” (=1 point), or “no improvement/this expectation does not apply to me” (=0 points). An overall score is calculated as the sum of all responses (range 0–100, higher is greater expectations); a clinically important difference is 20 points. Before surgery, surgeons completed an identical survey asking them to rate how much improvement they expected for each item for each of their patients. The surgeon's survey is scored similarly to generate an overall score (range 0–100). Concordance between scores for each patient-surgeon pair was measured with the intraclass correlation coefficient (ICC) for continuous data [range -1 (perfect disagreement), 0 (agreement no better than chance); +1 (perfect agreement)]. Results Patients completed the Expectations Survey a mean of 10 days before surgery; mean age 54 years, 51% men, mean ODI score 54 ± 13, 33% had a positive screen for depression, 16% had a diagnosis of acute herniated nucleus pulposus, and 84% had a degenerative condition. The 5 surgeons were age 37–59 years, in practice for 4–27 years, and all had completed a spine fellowship. The number of patients per surgeon ranged from 22–57. The mean Expectation Survey score was 73 ± 19 for patients and 57 ± 16 for surgeons. 87% of patients had higher scores (i.e., greater expectations) and 11% of patients had lower scores (i.e., lesser expectations) than their surgeons, and for 43% the difference exceeded a clinically important difference. The concordance in scores (ICC) between patient-surgeon pairs for the entire sample was 0.37. There were differences in ICC based on: demographic characteristics [men (0.47) versus women (0.27)]; diagnosis [acute herniated nucleus pulposus (0.55) versus degenerative condition (0.32)]; psychological status [negative screen for depression (0.43) versus positive screen for depression (0.22)]; and disability [better ODI score (0.46) versus worse ODI score (0.23)]. Conclusions There was wide variation in expectation scores between patients and their surgeons and for more than one third of patients this exceeded a clinically important difference. Lower concordance was not exclusively related to any particular feature but was associated with demographic, diagnostic, and clinical characteristics.
In individuals with rheumatoid arthritis (RA) and healthy controls, at enrollment and one year later, we evaluated relationships between diverse psychosocial characteristics and fatigue in multivariate analyses.Participants with RA and controls completed the Fatigue Severity Scale (FSS) at enrollment and again after one year. All participants also completed measures of depressive symptoms, anxiety, role satisfaction, social support, social stress, disability, physical activity, and sleep quality at enrollment.A total of 122 individuals with RA and 122 controls of similar age, sex, education, employment, and marital status were enrolled. Those with RA had more fatigue compared to controls (FSS scores 4.2 +/- 1.2 vs 3.4 +/- 1.1; p < 0.0001) (possible range 1-7, higher score = more fatigue). In cross-sectional multivariate regression analysis for the RA group, more fatigue was associated with more anxiety, more disability, less social support, and more social stress (p
The objective of this study was to identify the types of interactions between asthma patients and their social networks such as close family and friends that influence the management of asthma.
Erratum to: Clin Orthop Relat Res DOI 10.1007/s11999-017-5359-9 The authors of the published study, "What Demographic and Clinical Characteristics Correlate With Expectations With Trapeziometacarpal Arthritis?" would like to correct the following errors found in the Patients and Methods section of their paper. In the Patients and Methods section, the sentence describing the number of patients who chose injection and the number of patients who chose surgery is incorrect. The sentence should read: "Seventy-three patients chose injection (82%) and 16 patients (18%) chose surgery." Second, in the Patients and Methods section, the sentence describing the percentage of patients who listed their dominant hand side as the affected side is incorrect. The sentence should read: "Sixty-four percent of the patients had their dominant side as the affected side." Third, in Table 1, under the heading "History of depression or anxiety", the number of patients who reported a history of depression or anxiety is incorrect. Eight patients (10%), rather than 73, reported depression or anxiety, and 73 patients (90%), rather than 8, reported no history of depression or anxiety. The authors apologize for these errors.
