Articles: outcome.
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Multicenter Study
Intestinal Autotransplantation for Locally Advanced or Locally Recurrent Colon Cancer Invading SMA.
To examine the outcomes of intestinal autotransplantation (IATx) in patients with locally advanced (LACC) or locally recurrent (LRCC) colon cancer invading the superior mesenteric artery (SMA). ⋯ Extended resection for LACC or LRCC invading SMA can be performed safely and is associated with prolonged survival.
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Multicenter Study
Covert perioperative strokes in older patients having non-cardiac surgery (PRECISION): a prospective cohort analysis.
Perioperative strokes may promote postoperative neurocognitive dysfunction. This study thus evaluated the incidence of postoperative strokes and the association between strokes and postoperative neurocognitive outcomes in older patients recovering from noncardiac surgery. ⋯ Among patients aged 60 yr and older who had major noncardiac surgery, mainly intracranial, one in nine patients experienced a perioperative covert stroke. Covert strokes more than doubled the risk of postoperative delirium and long-term neurocognitive decline. Covert perioperative strokes are common and clinically meaningful.
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Multicenter Study
Provider Perceptions Regarding Cardiopulmonary Resuscitation in Surgical Patients with Frailty.
To characterize the perceptions of surgeons, anesthesiologists, and geriatricians regarding perioperative cardiopulmonary resuscitation (CPR) in surgical patients with frailty. ⋯ Anesthesiologists, surgeons, and geriatricians offer different accounts of frailty's relevance to judgments regarding CPR in surgical patients. Divergent views regarding frailty and perioperative CPR may impede efforts to deliver goal-concordant care and suggest a need for research to inform risk stratification, predict patient-centered outcomes, and understand the role of potential biases, such as ageism and ableism.
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Extracorporeal cardiopulmonary resuscitation (CPR) for refractory in-hospital cardiac arrest has been associated with improved survival compared with conventional CPR. Perioperative patients represent a unique cohort of the inpatient population. This study aims to describe and analyze the characteristics and outcomes of patients who received extracorporeal CPR for perioperative cardiac arrest. ⋯ The use of extracorporeal CPR for adults with perioperative cardiac arrest can be associated with excellent survival with neurologically favorable outcomes in carefully selected patients. Longer CPR time, higher lactate levels, and lower pH were associated with increased mortality. Given the small sample size, no other prognostic factors were identified, although certain trends were detected between survival groups.
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Spinal chordomas are primary bone tumors where surgery remains the primary treatment. However, their low incidence, lack of evidence, and late disease presentation make them challenging to manage. Here, we report the postoperative outcomes of a large cohort of patients after surgical resection, investigate predictors for overall survival (OS) and local recurrence-free survival (LRFS) times, and trend functional outcomes over multiple time periods. ⋯ Surgeons must often weigh the pros and cons of en bloc resection and sacrificing important but affected native tissues. Our findings can provide a benchmark for counseling patients with spinal chordoma. Tumors ≥100 cm 3 appear to have a 5.89-times higher risk of recurrence, mobile spine chordomas have a 7.73 times higher risk, and neoadjuvant radiotherapy confers an 11.1 times lower risk for local recurrence. Patients age ≥65 years at surgery have a 16.70 times higher risk of mortality than those <65 years.