COLECTOMY OUTCOMES IN PATIENTS OVER 65 WITH ULCERATION COLITIS

Introduction: There are limited data regarding surgical outcomes for elderly patients with Ulcerative Colitis, and we sought to examine the post operative outcomes in this population. Methods: The ACS NSQIP was queried for all patients with a diagnosis of ulcerative colitis and compared elderly patients (those aged 65 and older) to younger patients under age 65. Univariate and multivariate logistic regression was done to evaluate differences in morbidity and mortality rates. Results: 2,699 patients were analyzed, of which 493 (18.3%) were defined as elderly. Elderly patients had more comorbidities compared to younger patients but were less likely to be on preoperative steroids (47.1% vs 74.2%, p\u3c0.0001). Elderly patients had a higher proportion of emergent cases (27.6% vs 8.2%, p\u3c0.0001) and an average 3 day longer hospital stay, (p\u3c0.0001). There were no significant differences in the rates of anastomotic leak, surgical site infections or 30-day readmission. Elderly patients had a higher rate of morbidity (47.3% vs 26.8%, p\u3c0.0001) and mortality (8.9% vs 1.2%, p\u3c0.0001). Multivariate analysis showed elderly patients had significantly increased odds for morbidity (OR 2.45, 95% CI: 2.00-2.99, p\u3c0.0001) and 30-day mortality (OR 7.91, 95% CI: 4.85-12.91, p\u3c0.001). Preoperative sepsis significantly increased the risk of morbidity (OR 3.457, 95% CI: 2.27-5.26, p \u3c0.0001) and mortality (OR 3.11, 95% CI: 1.48-6.57, p\u3c0.003). Conclusions: Elderly patients with Ulcerative Colitis that undergo a colectomy are at increased risk for both morbidity and mortality. Optimizing these patients may reduce the risk, but further prospective trials are warranted to further elucidate the ideal optimization strategies.https://scholarlycommons.henryford.com/sarcd2021/1009/thumbnail.jp

Survival Rate Changes in Neonates with Congenital Diaphragmatic Hernia and its Contributing Factors

The purpose of this study was to demonstrate survival rate changes after the introduction of inhaled nitric oxide (iNO) therapy, and to identify the factors that influence these changes in neonates with a congenital diaphragmatic hernia (CDH) at a single center. A total of 48 neonates were divided into two groups based on the time of admission, i.e., into period I (P1; n=17; before the introduction of iNO therapy) and period II (P2; n=31; after the introduction of iNO therapy). Survival rates of the 48 neonates showed a tendency to increase from 53% during P1 to 77% during P2, but without a statistical significance, but a significant difference was found between survival rates during the two periods after adjusting for initial clinical characteristics, when the postoperative survival rate increased significantly from 69% for P1 to 100% for P2. The mean duration of preoperative respiratory management was significantly longer for P2 than for P1. Seven of 12 patients who received preoperative iNO therapy due to persistent pulmonary hypertension or refractory preductal hypoxemia in P2 survived after operation. We speculate that a management strategy based on iNO therapy and delayed operation, rather than differences between the initial clinical characteristics of the two study groups, might partially contribute to the observed improvements in postoperative and overall survival rates in neonates with CDH

Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome (Review)

Background: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are syndromes of severe respiratory failure that are associated with substantial mortality and morbidity. Artifical ventilatory support is commonly required and may exacerbate lung injury. Partial liquid ventilation (PLV) has been proposed as a less injurious form of ventilatory support for these patients. Although PLV has been shown to improve gas exchange and to reduce inflammation in experimental models of ALI, a previous systematic review did not find any evidence to support or refute its use in humans with ALI and ARDS. Objectives: The primary objective of this review was to assess whether PLV reduced mortality (at 28 d, at discharge from the intensive care unit (ICU), at discharge from hospital and at one, two and five years) in adults with ALI or ARDS when compared with conventional ventilatory support. Secondary objectives were to determine how PLV compared with conventional ventilation with regard to duration of invasive mechanical ventilation, duration of respiratory support, duration of oxygen therapy, length of ICU stay, length of hospital stay, incidence of infection, long-term cognitive impairment, long-term health related quality of life, long- term lung function, long-term morbidity costs and adverse events. The following adverse events were considered: hypoxia (arterial P