547 results on '"Postoperative pneumonia"'
Search Results
152. Relationship Between Postoperative Complications and the Prognosis of Gastric Carcinoma Patients Who Underwent Surgical Resection: A Systematic Review and Meta-Analysis
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Jun Wang, Muxing Kang, Kai-Bo Chen, Guofeng Chen, Xiaoli Jin, Jian Chen, Lele Lin, and Hang Zhang
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Surgical resection ,Poor prognosis ,medicine.medical_specialty ,Anastomotic Leak ,Gastric carcinoma ,anastomotic leakage ,survival ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Gastrectomy ,Risk Factors ,Stomach Neoplasms ,Humans ,Medicine ,gastric carcinoma ,postoperative pneumonia ,RC254-282 ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Pneumonia ,Hematology ,General Medicine ,Postoperative pneumonia ,Prognosis ,Surgery ,Oncology ,Anastomotic leakage ,030220 oncology & carcinogenesis ,Meta-analysis ,Wound Infection ,030211 gastroenterology & hepatology ,business ,Research Article - Abstract
Background: Whether the presence of postoperative complications was associated with poor prognosis of gastric carcinoma (GC) patients remain controversial. This meta-analysis was designed and reported to compare the survival difference between patients with complications and non-complications. Methods: Cochrane Library, PubMed and Embase databases were comprehensively searched for published literatures to review current evidence on this topic. The survival data were extracted, and a random-effect or fixed-effect model was used to analyze the correlation between postoperative complications and oncologic outcome of GC patients. Results: Of all studies identified, 32 were eligible for this pooled analysis, with a total of 32,067 GC patients. The incidence of postoperative complications was approximately 12.5% to 51.0%. Among them, infectious complications varied from 3.0% to 28.6%, anastomotic leakage varied from 1.1% to 8.7% and postoperative pneumonia varied from 1.6% to 12.8%. The presence of postoperative complications resulted in a significant poorer overall survival (OS) of gastric carcinoma patients (hazard ratio [HR]:1.49, 95% confidence interval [CI]: 1.33-1.67, P < 0.001). Additionally, the pooled results showed a significant correlation between infectious complications and decreased OS (HR: 1.61, 95%CI: 1.38-1.88, P < 0.001). Concerning specific postoperative complications, we found that both anastomotic leakage (HR: 2.36, 95%CI: 1.62-3.42, P < 0.001) and postoperative pneumonia (HR: 1.74, 95%CI: 1.22-2.49, P = 0.002) impaired the OS of gastric carcinoma patients. Conclusion: Postoperative complications were significantly correlated to recurrence and poor survival in gastric carcinoma patients. To gain a better surgical outcome and long-term oncological outcome, postoperative complications should be minimized as much as possible.
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- 2021
153. P130 Timing of nasogastric tube insertion and risk of postoperative pneumonia: international, prospective cohort study
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EuroSurg Collaborative
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body regions ,medicine.medical_specialty ,endocrine system diseases ,business.industry ,Poster Presentation ,medicine ,Nasogastric tube insertion ,nutritional and metabolic diseases ,General Medicine ,Postoperative pneumonia ,Prospective cohort study ,business ,Surgery - Abstract
Introduction This study aims to assess whether Prophylactic NGT insertion was associated with reduced rates of pneumonia, in comparison to Reactive NGT after colorectal surgery. Methods Pre-planned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January and April 2018 were included. Those receiving NGT were divided into three groups, based on the timing of the placement: Routine (at the time of surgery); Prophylactic (after surgery, before vomiting); and Reactive (after surgery, after vomiting). Pneumonia within 30 postoperative days was considered as primary outcome measure and it was compared between the three groups using multivariable regression analysis. Results 4,715 patients were included in the analysis. 1,536 (32.6%) received an NGT corresponding to 926 (60.3%) Routine, 461 (30%) Reactive and 149 (9.7%) Prophylactic. 200 patients (4.2%) developed pneumonia (No NGT: 2.7%; Routine NGT: 5.2%; Reactive NGT: 10.6%; Prophylactic NGT: 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the Prophylactic and Reactive NGT groups (OR: 1.03, 95% CI: 0.56 – 1.87, p = 0.932). Conclusion In patients who required NGT insertion after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery in comparison to reactive insertion.
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- 2021
154. Risk factors for postoperative pneumonia and prognosis in lung cancer patients after surgery
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Yao, Lijun, Luo, Jun, Liu, Lu, Wu, Qingchen, Zhou, Ruiqin, Li, Linjun, and Zhang, Cheng
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Male ,Lung Neoplasms ,overall survival ,Observational Study ,Prognosis ,lung cancer ,Logistic Models ,Postoperative Complications ,Treatment Outcome ,Risk Factors ,Odds Ratio ,acute physiology and chronic health evaluation II score ,Humans ,Female ,Pneumonectomy ,postoperative pneumonia ,Research Article ,APACHE ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies - Abstract
Postoperative pneumonia (POP) is one of the most frequent complications following lung surgery. The aim of this study was to identify the risk factors for developing POP and the prognostic factors in lung cancer patients after lung resection. We performed a retrospective review of 726 patients who underwent surgery for stages I–III lung cancer at a single institution between August 2017 and July 2018 by conducting logistic regression analysis of the risk factors for POP. The Cox risk model was used to analyze the factors influencing the survival of patients with lung cancer. We identified 112 patients with POP. Important risk factors for POP included smoking (odds ratio [OR], 2.672; 95% confidence interval [CI], 1.586–4.503; P
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- 2021
155. Development and Validation of a Risk Prediction Model for Postoperative Pneumonia in Adult Patients Undergoing Stanford Type a Acute Aortic Dissection Surgery: A Case Control Study
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Dashuai Wang, Xinling Du, Hongfei Wang, Xing Chen, Xiaofan Huang, and Sheng Le
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Aortic dissection ,medicine.medical_specialty ,Adult patients ,business.industry ,Case-control study ,medicine ,Postoperative pneumonia ,business ,medicine.disease ,Surgery - Abstract
BackgroundPneumonia is a common complication after Stanford type A acute aortic dissection surgery (AADS) and contributes significantly to morbidity, mortality, and length of stay. The purpose of this study was to identify independent risk factors associated with pneumonia after AADS and to develop and validate a risk prediction model.MethodsAdults undergoing AADS between 2016 and 2019 were identified in a single-institution database. Patients were randomly divided into training and validation sets at a ratio of 2:1. Preoperative and intraoperative variables were included for analysis. A multivariate logistic regression model was constructed using significant variables from univariate analysis in the training set. A nomogram was constructed for clinical utility and the model was validated in an independent dataset.ResultsPostoperative pneumonia developed in 170 of 492 patients (34.6%). In the training set, multivariate analysis identified seven independent predictors for pneumonia after AADS including age, smoking history, chronic obstructive pulmonary disease, renal insufficiency, leucocytosis, low platelet count, and intraoperative transfusion of red blood cells. The model demonstrated good calibration (Hosmer-Lemeshow χ2 = 3.31, P = 0.91) and discrimination (C-index = 0.77) in the training set. The model was also well calibrated (Hosmer-Lemeshow χ2 = 5.73, P = 0.68) and showed reliable discriminatory ability (C-index = 0.78) in the validation set. By visual inspection, the calibrations were good in both the training and validation sets.ConclusionWe developed and validated a risk prediction model for pneumonia after AADS. The model may have clinical utility in individualized risk evaluation and perioperative management.Clinical Trial Registry NumberChiCTR1900028127.
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- 2021
156. Nomogram prediction model of postoperative pneumonia in patients with lung cancer: A retrospective cohort study.
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Jin F, Liu W, Qiao X, Shi J, Xin R, and Jia HQ
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Background: The prediction model of postoperative pneumonia (POP) after lung cancer surgery is still scarce., Methods: Retrospective analysis of patients with lung cancer who underwent surgery at The Fourth Hospital of Hebei Medical University from September 2019 to March 2020 was performed. All patients were randomly divided into two groups, training cohort and validation cohort at the ratio of 7:3. The nomogram was formulated based on the results of multivariable logistic regression analysis and clinically important factors associated with POP. Concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow goodness-of-fit test and decision curve analysis (DCA) were used to evaluate the predictive performance of the nomogram., Results: A total of 1252 patients with lung cancer was enrolled, including 877 cases in the training cohort and 375 cases in the validation cohort. POP was found in 201 of 877 patients (22.9%) and 89 of 375 patients (23.7%) in the training and validation cohorts, respectively. The model consisted of six variables, including smoking, diabetes mellitus, history of preoperative chemotherapy, thoracotomy, ASA grade and surgery time. The C-index from AUC was 0.717 (95%CI:0.677-0.758) in the training cohort and 0.726 (95%CI:0.661-0.790) in the validation cohort. The calibration curves showed the model had good agreement. The result of DCA showed that the model had good clinical benefits., Conclusion: This proposed nomogram could predict the risk of POP in patients with lung cancer surgery in advance, which can help clinician make reasonable preventive and treatment measures., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Jin, Liu, Qiao, Shi, Xin and Jia.)
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- 2023
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157. Perioperative Microbiologic Monitoring of Sputum on Postoperative Day One as a Predictor of Pneumonia After Hepatectomy.
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Sakamoto, Kazuhiko, Tamesa, Takao, Tokuhisa, Yoshihiro, Matsukuma, Satoshi, Tokumitsu, Yukio, Maeda, Yoshinari, Takeda, Shigeru, Ueno, Tomio, Yamamoto, Shigeru, Yoshino, Shigefumi, Hazama, Shoichi, Nagano, Hiroaki, and Oka, Masaaki
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HEPATECTOMY , *PERIOPERATIVE care , *PNEUMONIA , *RETROSPECTIVE studies , *MULTIVARIABLE testing , *STAPHYLOCOCCUS aureus , *METHICILLIN resistance , *PATIENTS - Abstract
Background: The purpose of this study was to retrospectively evaluate microbial examination of sputum on postoperative day one (POD1) and to determine risk factors for postoperative pneumonia (POP) after hepatectomy. Methods: Two hundred ninety-four patients who expectorated sputum on POD1 after hepatectomy between 2003 and 2014 were investigated. Sputum samples were submitted for microbial examination. Risk factors for POP were identified using multivariable analysis. Results: One hundred fifty-eight (53.7 %) of 294 patients had bacteria in their sputum on POD1. POP was observed in 24 (8.2 %) patients, with increased mortality in the patients with POP (0.74 vs 12.5 %, p < 0.01). Multivariate analysis demonstrated that a Brinkman index of >400 and bacteria in sputum on POD1 were independent risk factors for POP. Bacterial homology in sputum obtained on POD1 and onset day of POP was found in 13 of the 24 (54.2 %) patients with POP. In particular, in 13 patients with POP caused by methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa, homology was confirmed in 9 patients (69.2 %). Conclusion: A Brinkman index ≥400 and bacteria in sputum on POD1 increased the risk of POP. Presence of bacteria in sputum on POD1 may be useful in determining early treatment against POP after hepatectomy. [ABSTRACT FROM AUTHOR]
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- 2015
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158. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery.
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Montravers, Philippe, Augustin, Pascal, Zappella, Nathalie, Dufour, Guillaume, Arapis, Konstantinos, Chosidow, Denis, Fournier, Pierre, Ribeiro-Parienti, Lara, Marmuse, Jean-Pierre, and Desmard, Mathieu
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POSTOPERATIVE care , *OBESITY treatment , *OBESITY , *SURGICAL complications , *GASTRECTOMY , *GASTRIC bypass , *DIAGNOSIS - Abstract
Perioperative complications following bariatric surgery (BS) have been poorly analysed and their management is not clearly assessed. The associated frequency of ICU admission is difficult to estimate. Among surgical complications, digestive perforations are the most frequent. The most common postoperative complications of sleeve gastrectomy are fistulas, but bleeding on the stapling line is also commonly reported. Complication rates are higher after Roux-en-Y gastric bypass, mainly due to anastomotic leaks. Medical complications are mainly thromboembolic or respiratory complications. All these surgical and medical complications are not easily detected; clinical signs can be atypical or insidious, often resulting in delayed management. Respiratory signs can be predominant and lead erroneously to pulmonary or thromboembolic diseases. Diagnostic criteria are based on minor clinical signs, tachycardia being probably the most frequent one. Lately, complications are revealed by haemodynamic instability, respiratory failure or renal dysfunction and radiographic findings. Management decision according to these abnormal signs is based on a combined multidisciplanary approach including surgical and/or endoscopic procedures and medical care, depending on the nature and severity of the surgical complication. Medical management is based on supportive ICU care of organ dysfunctions, curative anticoagulation if required, nutritional support, and appropriate anti-infective therapy. Pharmacological data are limited in morbidly obese patients and the appropriate doses are debated, especially for anti-infective agents. Complicated BS cases have a poor outcome, probably largely related to delayed diagnosis and reoperation. [ABSTRACT FROM AUTHOR]
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- 2015
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159. Effect of Preexisting Sarcopenia on Acute and Late Postoperative Pneumonia Among Patients With Oral Cavity Squamous Cell Carcinoma.
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Chen YN, Chiang CW, Tsai YH, Chen WM, Chen M, Shia BC, Huang CC, and Wu SY
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- Humans, Squamous Cell Carcinoma of Head and Neck, Cohort Studies, Retrospective Studies, Mouth Neoplasms complications, Mouth Neoplasms surgery, Carcinoma, Squamous Cell complications, Carcinoma, Squamous Cell surgery, Carcinoma, Squamous Cell pathology, Sarcopenia complications, Sarcopenia epidemiology, Head and Neck Neoplasms, Pneumonia epidemiology, Pneumonia etiology
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Background: Whether preexisting sarcopenia is an independent risk factor for postoperative pneumonia (POP) for patients with oral cavity squamous cell carcinoma (OCSCC) remains unclear. Therefore, we conducted a propensity score-matched population-based cohort study to compare the risk of acute and late POP for patients with sarcopenic and nonsarcopenic OCSCC who underwent curative surgery., Patients and Methods: We included patients with OCSCC who underwent curative surgery and categorized them into 2 groups depending on whether they had preexisting sarcopenia. The patients in the sarcopenic and nonsarcopenic groups were matched at a ratio of 2:1., Results: The matching process yielded 16,257 patients (10,822 without sarcopenia and 5,435 with sarcopenia). In multivariate Cox regression analyses, the adjusted hazard ratio of POP for the group with OCSCC with preexisting sarcopenia was 1.20 (95% CI, 1.14-1.26; P<.0001) compared with the nonsarcopenic group. Among the patients with OCSCC who received curative surgery, those in the sarcopenic group exhibited a higher POP risk than those in the nonsarcopenic group for the following postoperative time periods: 31st to 90th day, 91st day to first year, first to second year, second to third year, third to fourth year, and fourth to fifth year., Conclusions: The high incidence of pneumonia persists for a long time in patients with OCSCC who receive curative surgery; this high incidence may even persist for 5 years after surgery, especially in patients with sarcopenia. For susceptible patients who are at risk for OCSCC, sarcopenia prevention measures (eg, exercise and early nutrition intervention) should be implemented.
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- 2022
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160. Postoperative Pneumonia Increases the Risk of Venous Thromboembolism in Patients: A Propensity Score Analysis
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Matthew J. Bradley, Eric A. Elster, Patrick Benoit, Scott F. Grey, Peter A. Learn, Carolyn Gosztyla, and Rathnayaka M. Kalpanee D. Gunasingha
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medicine.medical_specialty ,business.industry ,Internal medicine ,Propensity score matching ,Medicine ,Surgery ,In patient ,Postoperative pneumonia ,business ,Venous thromboembolism - Published
- 2021
161. Postoperative Hypoalbuminemia: Prevalence, Risk Factors, Association with Postoperative Pneumonia in Brain Tumors Patients Undergoing Craniotomy
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Xu-Yang Zhang, Yi-bin Jiang, Da-wei Zhao, Dan Liu, Hua Feng, Shuixian Zhang, Rong Hu, and Kai-yan Wei
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medicine.medical_specialty ,Text mining ,business.industry ,hemic and lymphatic diseases ,Internal medicine ,medicine.medical_treatment ,medicine ,Hypoalbuminemia ,Postoperative pneumonia ,business ,medicine.disease ,Craniotomy - Abstract
Purpose Hypoalbuminemia is associatied with to poor outcome in patients undergoing surgery intervention. The main aim for this study was to investigate the incidence and the risk factors of postoperative hypoalbuminemia and assessed the impact of postoperative hypoalbuminemia on postoperative complications in patients undergoing brain tumor surgery. Methods This retrospective study included 372 consecutive patients who underwent craniotomy for brain tumors from January 2017 to December 2019. The demographic data, pre- and post-operative laboratory tests and postoperative complications were collected. The patients were divided into two groups based on the postoperative serum albumin levels; hypoalbuminemia group (
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- 2021
162. The safety and feasibility of intra-corporeal gastroduodenostomy using a self-pulling and latter transected method (Delta SPLT) in totally laparoscopic distal gastrectomy
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Luchun Hua, Yaping Wang, Han-Kun Hao, Jun Hong, and Jian Wang
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Male ,medicine.medical_specialty ,Duodenum ,Anastomosis ,Gastroduodenostomy ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Gastrectomy ,Stomach Neoplasms ,Medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Anastomosis, Surgical ,Delta shaped anastomosis ,General Medicine ,Perioperative ,Postoperative pneumonia ,Middle Aged ,Surgery ,Safety profile ,Oncology ,030220 oncology & carcinogenesis ,Operative time ,030211 gastroenterology & hepatology ,Female ,Laparoscopy ,business ,Gastroenterostomy ,Laparoscopic distal gastrectomy - Abstract
Background and objectives In 2016, the self-pulling and latter transection method (named "Delta SPLT"), a modified delta-shaped gastroduodenostomy (DA) technique for totally laparoscopic distal gastrectomy, was described. Delta SPLT reduced the technical difficulty of the surgery and the quantity of cartridges required with a manageable initial safety profile. Here, the safety and feasibility of this technique are analyzed at 1 year's follow-up. Methods The demographic and clinicopathologic profiles, perioperative details, and postoperative outcomes of 45 consecutive patients who underwent Delta SPLT from March 2016 to March 2019 were retrospectively analyzed. The Delta SPLT technique, which consisted of one endoscopic linear stapler and four cartridges each, was used for reconstruction in every case. Results The mean operative time was 127.1 ± 38.2 min, including a reconstruction duration of 22.6 ± 7.2 min. There were no surgical or anastomotic complications. The mean postoperative stay duration was 5.8 ± 1.2 days, and the morbidity rate was 2.2% with one case of postoperative pneumonia. Conclusions The results at the one-year follow-up suggest that Delta SPLT is a safe and feasible procedure. Delta SPLT is characterized by fewer difficulties experienced during surgery, lower surgical costs, it is easy to practice, and it is beneficial for patients who are undergoing gastroduodenostomy.
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- 2021
163. Effects of different oral care strategies on postoperative pneumonia in infants with mechanical ventilation after cardiac surgery: a prospective randomized controlled study
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Qi-Liang Zhang, Ning Xu, Shu-Ting Huang, Zeng-Chun Wang, Qiang Chen, Hua Cao, and Xian-Rong Yu
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Mechanical ventilation ,medicine.medical_specialty ,Sodium bicarbonate ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Postoperative pneumonia ,Breast milk ,Intensive care unit ,law.invention ,Cardiac surgery ,chemistry.chemical_compound ,stomatognathic diseases ,chemistry ,Randomized controlled trial ,law ,Anesthesia ,Pediatrics, Perinatology and Child Health ,medicine ,Original Article ,business - Abstract
Background To explore the effects of different oral care strategies on postoperative pneumonia in infants with mechanical ventilation after cardiac surgery. Methods A prospective randomized controlled study was conducted at a hospital in Fujian Province, China. Participants were randomly divided into the breast milk oral care group, physiological saline oral care group, and sodium bicarbonate oral care group to explore the effects of different oral care strategies on postoperative pneumonia in infants on mechanical ventilation cardiac surgery. Results The mechanical ventilation duration, the hospitalization costs, and the length of intensive care unit (ICU) stay and postoperative hospital stay in the breast milk oral care group were significantly shorter than those in the physiological saline oral care group and the sodium bicarbonate oral care group. The incidence of postoperative pneumonia in the breast milk oral care group was 3.2%, which was significantly lower than that in the physiological saline oral care group (22.6%) and the sodium bicarbonate oral care group (19.4%). Conclusions Using breast milk for oral care in infants after cardiac surgery has a lower incidence of postoperative pneumonia than traditional oral care strategies of physiological saline and sodium bicarbonate, and it is worthy of clinical application.
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- 2021
164. Resistance to Preoperative Oral Care Is Associated With Postoperative Pneumonia After Oesophageal Cancer Surgery
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Hiroyuki Kuwano, Kengo Kuriyama, Takuya Asami, Keigo Hara, Makoto Sohda, Hideyuki Saito, Takayoshi Watanabe, Makoto Sakai, Hiroshi Saeki, Satoshi Yokoo, Tomonori Yoshida, Mai Kim, and Ken Shirabe
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Male ,Cancer Research ,medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Oral hygiene ,Sensitivity and Specificity ,Perioperative Care ,Postoperative Complications ,Oesophageal surgery ,Internal medicine ,Preoperative Care ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,Cancer ,General Medicine ,Perioperative ,Pneumonia ,Postoperative pneumonia ,Middle Aged ,medicine.disease ,Oral Hygiene ,Esophagectomy ,stomatognathic diseases ,Oncology ,Multivariate Analysis ,Female ,Complication ,business ,Cancer surgery - Abstract
BACKGROUND/AIM Postoperative pneumonia is a serious complication of major oesophageal surgery. We aimed to clarify the association between the degree of improvement in oral hygiene by perioperative oral care and postoperative pneumonia in oesophageal cancer patients. PATIENTS AND METHODS Oesophageal cancer patients (n=129) who underwent esophagectomy received perioperative oral care. Their oral hygiene was evaluated using the Oral Assessment Guide (OAG). The relationship between perioperative OAG scores and postoperative complications was analysed. RESULTS The average OAG scores before starting oral care, pre-operation, and post-operation were 11.0±1.7, 9.1±1.5, and 11.2±3.0, respectively (p
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- 2021
165. Development and Validation Of Nomogram Models For Postoperative Pneumonia In Adult Patients Undergoing Elective Cardiac Surgery
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Dashuai Wang, Fei Xie, Hongfei Wang, Jia Wu, Xinling Du, Sheng Le, Xing Chen, Xiaofan Huang, and Ximei Li
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History ,medicine.medical_specialty ,genetic structures ,Polymers and Plastics ,Adult patients ,business.industry ,Univariate ,Retrospective cohort study ,Nomogram ,Postoperative pneumonia ,Logistic regression ,Industrial and Manufacturing Engineering ,Cardiac surgery ,Emergency medicine ,medicine ,Business and International Management ,Risk factor ,business - Abstract
Background: Postoperative pneumonia (POP) is a frequent complication following cardiac surgery, related to increased morbidity, mortality and healthcare costs. The objectives of this study were to investigate the predictors associated with POP in adults undergoing elective cardiac surgery and to develop and validate nomogram models. Methods: We conducted a multicenter retrospective study in four cardiac centers in China. Adults operated with elective open-heart surgery from 2016-2020 were included. Patients were randomly allocated to training and validation sets by 7:3 ratio. Risk factors for POP were identified by univariate and multivariate analysis. Nomograms were constructed based on the multivariate logistic regression models and were evaluated with calibration, discrimination and decision curve analysis. Findings: A total of 13,380 patients meeting the criteria were included and POP developed in 882 patients (6.6%). The mortality was 2.0%, but it increased significantly in patients with POP (25.1% versus 0.4%, P
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- 2021
166. Preoperative Albumin-to-Fibrinogen Ratio Predicts Postoperative Pneumonia in Patients with Esophageal Squamous Cell Carcinoma: A Retrospective Study
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Peng Zhang and Song Zhao
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Albumin ,Retrospective cohort study ,In patient ,Postoperative pneumonia ,business ,Fibrinogen ,Gastroenterology ,Esophageal squamous cell carcinoma ,medicine.drug - Abstract
Background: Postoperative pneumonia is the most common postoperative complication in patients with esophageal cancer. Prediction of postoperative pneumonia by establishing a preoperative physiological function parameter model can help patients make adequate preoperative preparation, reduce treatment costs, and improve prognosis and quality of life. The purpose of this study was to investigate the relationship between albumin, fibrinogen, albumin-to-fibrinogen ratio(AFR) , and other preoperative laboratory tests and postoperative pneumonia in patients with esophageal cancer after esophagectomy.Methods: Retrospective analysis was performed on 177 consecutive patients who underwent esophagectomy in the Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University from December 2018 to December 2019.Postoperative pneumonia was defined according to the revised Uniform Pneumonia Score(rUPS).Patients were divided into pneumonia and non-pneumonia groups for comparison of baseline data, perioperative indicators, and laboratory examination data.(Receiver operating characteristic)ROC curve analysis was used to evaluate the efficacy, sensitivity and specificity of AFR, and Youden’s index was used to calculate the cut-off values of AFR and other laboratory tests data. Univariate and multivariate logistic regression analyses were used to assess the risk factors for postoperative pneumoniaResults: Of the 177 patients, 32 (18%) developed postoperative pneumonia. The AUC value predicted by AFR using ROC curve analysis was 0.767, 65.6% sensitivity and 83.4% specificity. Multivariate logistic regression analysis showed that albumin (P=0.013), creatinine (P=0.01), and AFR (P=0.016) were independent risk factors for postoperative pneumonia.Conclusion: Preoperative AFR can effectively predict the occurrence of postoperative pneumonia in patients with esophageal cancer
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- 2020
167. Involvement of cough reflex impairment and silent aspiration of oral bacteria in postoperative pneumonia: a model of aspiration pneumonia
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Sato, Takuichi, Hoshikawa, Yasushi, Kondo, Takashi, Hashimoto, Kazuhiro, Abiko, Yuki, Hasegawa, Ayako, Matsuyama, Junko, Takahashi, Nobuhiro, Sasano, Takashi, editor, and Suzuki, Osamu, editor
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- 2010
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168. Neuromuscular Blocking Drugs and Postoperative Pulmonary Complications
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Mathews, Letha and Ehrenfeld, Jesse M.
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- 2018
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169. Relationship Between Cytokine Gene Polymorphisms and Risk of Postoperative Pneumonia with Esophageal Cancer.
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Sakamoto, Kazuhiko, Oka, Masaaki, Yoshino, Shigehumi, Hazama, Shoichi, Takeda, Shigeru, Yoshimura, Kiyoshi, Okayama, Naoko, and Hinoda, Yuji
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CYTOKINES , *GENETIC polymorphisms , *POSTOPERATIVE care , *RISK factors of pneumonia , *ESOPHAGEAL cancer , *RETROSPECTIVE studies , *MULTIVARIATE analysis - Abstract
Background: We retrospectively evaluated the relationship between cytokine gene polymorphisms and development of postoperative pneumonia after esophagectomy. Methods: In 120 patients who underwent esophagectomy, serum samples were obtained to measure levels of serum interleukin (IL)-6 and IL-10 at four time points (preoperatively, postoperative day (POD)0, POD1, and POD3). DNA extracted from peripheral blood in all patients was analyzed to determine polymorphisms of cytokines such as tumor necrosis factor-α -1031 T/C, IL-1β -511C/T, IL-6 -634C/G, and IL-10 -819 T/C. Results: Postoperative pneumonia arose in 34 patients (28.3 %). Perioperative serum IL-10 levels were significantly higher for IL-10 -819 C/T + C/C genotypes than for T/T genotypes (POD0 16.7 ± 2.84 vs. 8.54 ± 0.87 pg/ml, p = 0.0002; POD1 14.0 ± 2.64 vs. 8.8 ± 0.87 pg/ml, p = 0.0143; POD3 8.9 ± 2.67 vs. 4.4 ± 0.52 pg/ml, p = 0.0076). The frequency of the IL-10 -819 T/T genotype was significantly higher in patients with postoperative pneumonia than in patients without pneumonia ( p = 0.0323). Multivariate analysis of factors such as sex, smoking, length of operation, field of lymph node dissection, and IL-10 polymorphism identified IL-10 polymorphism as independent predictor of postoperative pneumonia. Conclusions: Patients with IL-10 -819 T/T genotype may be at high risk for postoperative pneumonia after esophagectomy. [ABSTRACT FROM AUTHOR]
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- 2014
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170. Risk Factors for Postoperative Pneumonia After Cardiac Surgery and Development of a Preoperative Risk Score.
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Allou, Nicolas, Bronchard, Regis, Guglielminotti, Jean, Dilly, Marie Pierre, Provenchere, Sophie, Lucet, Jean Christophe, Laouénan, Cédric, and Montravers, Philippe
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COMPLICATIONS of cardiac surgery , *PNEUMONIA , *MULTIVARIATE analysis , *LUNG diseases , *MEDICAL research - Abstract
Objectives: The aims of this study were, first, to identify risk factors for microbiology-proven postoperative pneumonia after cardiac surgery and, second, to develop and validate a preoperative scoring system for the risk of postoperative pneumonia. Design and Setting: A single-center cohort study. Patients: All consecutive patients undergoing cardiac surgery between January 2006 and July 2011. Interventions: None. Measurements and Main Results: Multivariate analysis of risk factors for postoperative pneumonia was performed on data from patients operated between January 2006 and December 2008 (training set). External temporal validation was performed on data from patients operated between January 2009 and July 2011 (validation set). Preoperative variables identified in multivariate analysis of the training set were then used to develop a preoperative scoring system that was validated on the validation set. Postoperative pneumonia occurred in 174 of the 5,582 patients (3.1%; 95% CI, 2.7-3.6). Multivariate analysis identified four risk factors for postoperative pneumonia: age (odds ratio, 1.02; 95% CI, 1.01 -1.03), chronic obstructive pulmonary disease (odds ratio, 2.97; 95% CI, 1.8-4.71), preoperative left ventricular ejection fraction (odds ratio, 0.98; 95% CI, 0,96-0.99), and the interaction between RBC transfusion during surgery and duration of cardiopulmonary bypass (odds ratio, 2.98; 95% CI, 1.96-4.54). A 6-point score including the three preoperative variables then defined two risk groups corresponding to postoperative pneumonia rates of 1.8% (score < 3) and 6.5% (score > 3). Conclusion: Assessing preoperative risk factors for postoperative pneumonia with the proposed scoring system could help to implement a preventive policy in high-risk patients with a risk of postoperative pneumonia greater than 4% (i.e., patients with a score >3). [ABSTRACT FROM AUTHOR]
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- 2014
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171. Effectiveness of an outpatient preoperative care bundle in preventing postoperative pneumonia among esophageal cancer patients.
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Tamae Hiramatsu, Makiko Sugiyama, Setsuko Kuwabara, Yuji Tachimori, and Midori Nishioka
- Abstract
Background: This historical case-control study examined the effectiveness of an outpatient preoperative care bundle on the incidence of postoperative pneumonia among patients with esophageal cancer. Methods: We implemented a preoperative care bundle that comprised 7 care procedures that previous studies had suggested to be effective for decreasing postoperative respiratory complications, infections, postoperative hospital stay, and mortality. The care bundle group included patients who underwent surgery after the care bundle was implemented, whereas the control group included those who underwent surgery before its implementation. Results: The incidence of postoperative pneumonia was 3.8% in the care bundle group (1/26) and 22.4% in the control group (48/214). A logistic regression model showed that implementation of the care bundle had a significant effect on prevention of postoperative pneumonia (odds ratio, 0.16; 95% confidence interval: 0.01-0.94) after controlling the following confounding factors: sex, blood urea nitrogen, amount of blood loss, recurrent laryngeal nerve palsy, and preoperative hospital stay. Conclusion: Implementation of the procedures of the preoperative care bundle was shown to be effective for preventing postoperative pneumonia in patients with esophageal cancer. [ABSTRACT FROM AUTHOR]
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- 2014
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172. Multi-institution retrospective study of the onset frequency of postoperative pneumonia in thoracic esophageal cancer patients.
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Tsubosa, Yasuhiro, Sato, Hiroshi, Tachimori, Yuji, Hokamura, Nobukazu, Hosokawa, Masao, Kinoshita, Yoshihiro, Daiko, Hiroyuki, Udagawa, Harushi, Ueno, Masaki, Seto, Yasuyuki, Jinbo, Keiichi, Kitagawa, Yuko, Takeuchi, Hiroya, Park, Mijong, Nagasaka, Shiori, Yamada, Hiroshi, and Ota, Yojiro
- Abstract
Background: Esophagectomy for thoracic esophageal cancer is a highly invasive procedure. Most studies analyzing the risk factors for pulmonary morbidity were conducted in the early 1990s. However, previous studies did not use fixed diagnostic criteria for postoperative pneumonia and reported widely varying onset frequencies. Purpose: To define postoperative pneumonia diagnostic criteria, clarify the onset frequency of postoperative pneumonia after esophagectomy in accordance with these criteria, and investigate the risk factors of postoperative pneumonia. Methods: Risk factors for postoperative pneumonia were analyzed in 615 patients who underwent esophagectomy between January 2006 and December 2007 at 7 Japanese institutions using logistic regression models. The necessary criterion for a pneumonia diagnosis was an infiltrative shadow on a chest radiograph. Furthermore, a pneumonia diagnosis was based on the presence of at least 2 of the following 3 criteria: white blood count abnormalities, body temperature of 38 °C or higher, and purulent sputum. Results: Overall, 615 patients were statistically analyzed. Pneumonia onset occurred in 66 cases (10.7 %). The risk of postoperative pneumonia was associated with a preoperative body weight loss of 5 % or more and late tracheal tube extubation. Conclusions: This study revealed that preoperative body weight loss increased the risk of postoperative pneumonia after esophagectomy for esophageal cancer, while early-stage tracheal tube extubation reduced the risk. [ABSTRACT FROM AUTHOR]
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- 2014
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173. Postoperative Pneumonia Following Open Heart Surgery
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Siraj M Eid, Omar A Alsulami, Khalid Al-Ebrahim, Abdulhadi E Konkar, Hazem A Alsulami, Abdulrahman A Alalyani, and Muath S Alghamdi
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medicine.medical_specialty ,Blood transfusion ,medicine.medical_treatment ,education ,Infectious Disease ,030204 cardiovascular system & hematology ,Hospital-acquired pneumonia ,law.invention ,surgery ,03 medical and health sciences ,0302 clinical medicine ,law ,medicine ,pneumonia ,operative complication ,postoperative pneumonia ,business.industry ,Incidence (epidemiology) ,General Engineering ,Postoperative complication ,Retrospective cohort study ,medicine.disease ,infection control ,Intensive care unit ,Cardiac surgery ,Surgery ,Pneumonia ,hospital acquired pneumonia ,Cardiac/Thoracic/Vascular Surgery ,business ,cardiac surgery ,030217 neurology & neurosurgery - Abstract
Objectives This study aimed to measure the incidence and record the relations between risk factors of postoperative pneumonia (POP) among patients who underwent open heart surgery in a single hospital in Saudi Arabia. Methods This retrospective cohort study was conducted in June 2019 at King Abdulaziz University hospital in Saudi Arabia. Data including general information, comorbidities, lab investigations, preoperative risk factors, intraoperative considerations, and postoperative elements were collected and analyzed. Results A total of 255 cardiac surgeries were performed from November 2014 to June 2019. Two hundred of the 255 cardiac surgeries were analyzed as open-heart surgeries. Only five patients were diagnosed with POP after open heart surgery with an incidence of 2.5%. The mean age of these patients was 47±18 years, more than half of them were smokers, three were hypertensive, four were classified as ASA 4, and three underwent the operation electively. The mean bypass time was 100.3 ± 24.5 min, the mean duration of operation was 199 ± 86.2 min, the mean postoperative intensive care unit (ICU) stay was 97.4 ± 83.4 hours, and the mean overall hospital stay was 10.4 ± 7.2 days. We observed significant differences in only the following correlations: amount of blood transfusion with ICU stay and with the overall hospital stay. Conclusion The incidence of developing postoperative pneumonia in patients undergoing open heart surgery in the King Abdulaziz University hospital from November 2014 to June 2019 was 2.5%, indicating a high-quality level of surgical technique and proper infection control.
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- 2020
174. Impacts of seasonal variation on postoperative pneumonia after coronary artery bypass grafting
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Teruhiko Imamura
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Bypass grafting ,business.industry ,Pulmonary disease ,Coronary Artery Disease ,Pneumonia ,Postoperative pneumonia ,medicine.disease ,Coronary artery disease ,medicine.anatomical_structure ,Postoperative Complications ,Internal medicine ,medicine ,Cardiology ,Humans ,Surgery ,Seasons ,Coronary Artery Bypass ,Cardiology and Cardiovascular Medicine ,business ,Artery - Published
- 2020
175. Risk Factors for Postoperative Myasthenic Crisis After Thymectomy in Patients With Myasthenia Gravis
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Julong Guo, Lei Su, Ying Huang, Chunmei Wang, and Yi Zhang
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Adult ,Male ,endocrine system ,Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,law ,Risk Factors ,Myasthenia Gravis ,medicine ,Humans ,In patient ,Aged ,Retrospective Studies ,Mechanical ventilation ,business.industry ,Thoracic Surgery, Video-Assisted ,digestive, oral, and skin physiology ,Myasthenic crisis ,Immunoglobulins, Intravenous ,Postoperative pneumonia ,Middle Aged ,medicine.disease ,Thymectomy ,Intensive care unit ,Respiration, Artificial ,Myasthenia gravis ,Pneumonia ,Logistic Models ,nervous system ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
The objective of this study is to characterize postoperative myasthenic crisis (POMC), after extended thymectomy and discuss the treatment options for this condition.Clinical data from patients with generalized myasthenia gravis (MG) who underwent extended thymectomy at Xuanwu Hospital of the Capital Medical University from 2016 to 2018 were reviewed retrospectively. Patients were divided into two groups-POMC and non-POMC. Variables that could potentially predict POMC were analyzed. In the POMC group, the aforementioned variables were compared between patients with and without pneumonia.Ninety-seven patients were enrolled. Thirty-eight (39.2%) patients developed POMC. The mean duration of mechanical ventilation (MV), length of intensive care unit stay, and duration of hospital stay were significantly longer in the POMC group (P 0.001). Multivariate logistic regression analysis showed that disease severity, symptom duration longer than 12 mo, and transsternal thymectomy were independent risk factors for POMC. Postoperative pneumonia significantly prolonged the MV period (P = 0.012) and weaning from MV after intravenous immunoglobin (IVIg) treatment (P = 0.005) in POMC patients. Twenty-four (24.7%) POMC patients who received IVIg were successfully weaned from MV and were discharged.Disease severity, symptom duration longer than 12 mo, and transsternal thymectomy were independent risk factors for POMC. Postoperative pneumonia worsens the prognosis of POMC.
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- 2020
176. Predictors of early postoperative pneumonia after oncologic surgery with the patients receiving professional oral health care: A prospective, multicentre, cohort study
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Jiro Sunami, Hiroshi Nagasaka, Shigeaki Yanase, Ruriko Souta, Hidenori Okumura, Yoshito Takasaki, Hiroshi Otsuru, Kohei Marukawa, Hidenobu Senpuku, Maho Takashima, Takeshi Nakashima, Norimichi Nakamoto, Hiroshi Iwabuchi, Yasutoshi Honda, Takumi Arika, Akihide Negishi, Takeshi Usami, Kohji Tanaka, Yuuko Watanabe, Rishiho Nishizawa, Yoshiaki Otsuka, Hiromasa Yoshikawa, Toshiaki Shinya, Yasuhiko Tsutsumi, Kenji Negoro, Shinichi Nozaki, and Mikihito Kajiya
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medicine.medical_specialty ,biology ,business.industry ,General Medicine ,Perioperative ,Pneumonia ,030230 surgery ,Postoperative pneumonia ,biology.organism_classification ,Logistic regression ,Oncologic surgery ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,Humans ,Oral health care ,Prospective Studies ,Candida albicans ,business ,Delivery of Health Care ,Cohort study - Abstract
This study was a prospective, multicentre, cohort study on 685 patients who had undergone oncologic surgery. The patients were divided into two groups according to the presence or absence of postoperative pneumonia. The two groups were compared with respect to their background, index operation, food eaten, oral condition, contents of oral care and dental treatment, laboratory data, and bacterial flora. All postoperative pneumonias occurred in six cases within four days postoperatively. The multivariable logistic regression analysis showed that preoperative serum C-reactive protein was the strongest predictor of postoperative pneumonia. In addition, decreased postoperative Candida albicans colonies was an effective predictor of postoperative pneumonia. For patients with predictors of postoperative pneumonia, perioperative strategies for its prevention should be considered in addition to professional oral health care. This study was approved by the National Hospital Organization’s Central Ethics Review Board and was also approved by the directors of the participating institutions.
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- 2020
177. Effect of oral plaque control on postoperative pneumonia following lung cancer surgery
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Mingxia Sun, Chunling Jia, Cuirong Li, Xiaoying Zhang, Xibo Li, and Weizhi Wang
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,Male ,Dental plaque ,medicine.medical_specialty ,China ,Lung Neoplasms ,genetic structures ,Plaque control ,lcsh:RC254-282 ,surgery ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,plaque control ,Risk Factors ,Internal medicine ,medicine ,Humans ,Lung cancer ,Pneumonectomy ,postoperative pneumonia ,Retrospective Studies ,Lung cancer surgery ,business.industry ,Incidence (epidemiology) ,Incidence ,Retrospective cohort study ,General Medicine ,Odds ratio ,Pneumonia ,Original Articles ,Postoperative pneumonia ,Middle Aged ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prognosis ,lung cancer ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Female ,Original Article ,business ,Follow-Up Studies - Abstract
Background There have been few studies on the relationship between oral status and postoperative pneumonia (POP) in patients with lung cancer, and whether improving their oral condition assists with a lower incidence of POP before lung cancer surgery remains controversial. This retrospective study was conducted by a stomatologist to assess the effect of controlling oral pathogenic bacteria of patients with lung cancer to prevent POP. Methods A total of 235 patients with lung cancer who underwent lobectomy by open thoracotomy between July 2015 and December 2018 were selected and given the choice of being in the experimental or control group. A total of 122 participants in the experimental group received professional oral plaque control, and 113 participants in the control group did not receive plaque control. All clinical data of participants in both groups were retrospectively studied to determine the incidence of POP at the thirtieth day of discharge from hospital. Results Eight in the experimental group and six in the control group were excluded from the study. It was found that four of 114 patients suffered from POP in the experimental group (incidence = 3.51%). A total of 17 of 107 patients in the control group had pulmonary infection (incidence = 15.89%). Odds ratio was 0.19. The incidence of POP in the experimental group was significantly lower than that of the control group (P
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- 2020
178. Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study
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Glasbey J. C., Bibi S., Pata F., Ozkan B. B., Van Straten S., Hodson J., Chapman S. J., Blanco-Colino R., Pellino G., Sgro A., Soares A., van Elst T., Nepogodiev D., Borakati A., Bath M. F., Yasin I. H., Mclean K., Arthur T., Kovacevic M., Delibegovic S., Karamanliev M., Swamad M., Zebrak R., Paramasivam R., Martensen A., Larsen H. M., Radeker L., Frey P. E., Kechagias A., Venara A., Duchalais E., Ioannidis A., Pasquali S., Simioni A., Farina V., Podda M., Lorenzon L., ItSURG I., Schaeff V., Otto A., Jakubauskas M., van Elst T. R., Chu M., Fagan P. V. B., Wells C. I., Alagoa Joao A., Juloski J., Perez-Ajates S., Anabitarte Bautista O., El Kasmy Y., Espin-Basany E., Clerc D., Ciubotaru C., Popescu S., Yanishev A., Lee S., Yagiz Sen A., Aktas M. K., Baki B. E., Yuksek B., Kamarajah S., Khaw R. A., Mills E., Goodson R., Thakral N., Collaborative S., Ablett A. D., Adra M., Kwek I., Khan S. M., Quinn P., Manley L. R., Badran A., Ramjeeawon A., Campbell A., Tan H. L., Rye D. S., Rajaraman N., Norman J. G., Vutipongsatorn K., Solomou G., Akhbari M., Ali A., Murray V., Baker D. M., Brandao B. D., Stainer B., Thavayogan R., Jones D., Onafowokan O. O., Gharooni A., Dabab N., Carlton-Carew S., Kungwengwe G., Gabriel M., Sewart E., Shortland T. C., Lawday S., Pockney P., Dawson A., Brumfitt C. D., Stewart P., Ng B., Luong J. K., Ivanov V., Borisova A., Neykov V., Kuncarova K., Kolosova B., Antonova T., Farkasova M., Harbjerg J. L., Brandsborg S., Brinck S., Kjaer M. D., Mark-Christensen A., Unbehaun K. P., Dalsgaard P., Lycke K. D., LeNaoures P., Brigand C., Dumange E., Gout M., Moehwald C., Prem M., Alhalabi O., Sliwinski S., Krupp J., Gablenz E., Schmitzer L., Kopp A., Steinle J., Gsenger J., Pohl L. J., Riccardi M., Christodoulou I. M., Konstantinidis M., Machairas N., Zoikas A., Balalis D., Manatakis D. K., Aguilera M. L., Marano L., Fleres F., Lovisetto F., Sasia D., Segalini E., Pata G., Lucchi A., Sagnotta A., Campagnaro T., Petrelli F., Gallo G., Papandrea M., Testa V., Sinibaldi G., Di Candido F., Colombo F., Perrone G., Biancafarina A., Canonico G., Pagnanelli M., Curletti G., Bini R., de Manzoni Garberini A., Impellizzeri H., Cillara N., Tutino R., Picciariello A., Coletta D., Savino G., Ferrara F., Tamini N., Talamo G., Parini D., Giamundo P., lo Conte A., Pagano G., Ripetti V., Pesce A., Menduni N., Giudicissi R., Goldin E., Rega D., Belli A., Andriola V., Gordini L., Foppa C., Piccolo G., Birindelli A., Ferrari C., Ballarini Z., Tirelli F., Milone M., De Rosa M., Pipitone Federico N. S., Molteni B., Tilocca P. L., Sancini G., Piozzi G. N., Lauretta A., Poillucci G., Mulas S., Simcikas D., Portelli L., van Wijnbergen J. W. M., Dinger T. L., ten Doesschate S. F. H., van Dalen A. S. H. M., van den Bos D. D., Hansmann M., Medina Feliz J., Kuiper S. Z., Abdulrahman Z., Pruijssers S. R., Farik S., Elliott B. M., Geneta V. P., Wilton S., Kandelaki H., Peng S. L., Campbell S., Lim Y. K., Yassaie S. S., Murray M., Haran C., Tan J., Castro J., Laranjeira A., Catarino S., Neves-Marques C., Correia J. G., Vieira B. N., Quintela A. C., Serra M. L., Maciel J., Cunha M., Aparicio D. J., Neves J., Azevedo J., Romano M., Eiro F., Romano J., Monteiro C., Claro M., Almeida M. R., Peyroteo M., Machado N. D., Capote H., Ferreira M., Sousa X., Devesa H., Cavadas D., Guerreiro I., Costa M., Rosete M., Salman M., English C., Mohammed N., Litvin A., Cuk V. V., Meszarosova K., Jaich R., De Lima H., Brooks S., Marx M., Nshalati Salvation M., Garcia Cardo J., Mora-Guzman I., Sancho Muriel J., de Andres Olabarria U., Muriel P., Jimenez Vinas C., Alconchel F., Esteban Sinovas O., Gomez del Pulgar A., Fairen Oro C., Lopez Otero M., Figueroa Jimenez S., Claramonte Bellmunt O., Martinez Caballero J., Rubio-Perez I., Aguilar-Martinez M. M., Segura-Sampedro J. J., Olmedo Moreno C., Negre Parra D., Estevez Diz A. M., Martin-Balbuena R., Bustamante Recuenco C., Licardie Bolanos R. E., Fernandez P., Diaz Padillo A., Forero-Torres A., Alberdi San Roman I., Salvador Roses H., Merayo Alvarez M., Villarejo Campos P., Lopes Moreira C. C., Uriol Peralta P., Serrano Navidad M., Ripolles-Melchor J., Garcea A., Gomez Facundo H., Troncoso Pereira P., V Perez Guarinos C., Blaser B., Piazza G., Gagliardi B., Serin H., Yurdaor S. S., Arslan E., Kopac O., Uyanik A., Ozmen B. B., Tiftik E., Aksoy B., Yalcinkaya A., Ozoglu F., Kocer M. D., Bilicen G., Cinar E. N., Uslu O., Kaya Y., Demirci K., Wong J., Farhan-Alanie M. M. H., Suresh G., Asif A., Finch B. J., Bhahirathan Y., Herron J., Yi Tew Z., Obukofe R., Russell C., Suchett-Kay I., Netke T., Williams L., Kisiel A., Liu F. Y., Claireaux H., James P., Mondal A., Kalderon R., Nadama H. H., Al-Saraff Z., Tam J. P. H., Powell-Chandler A., Wood F., Gorgievska R., Ragavoodoo A., Thakrar C., Rojoa D., Palmer C., Davidson K., Giacci L., Hale J., Gan F. W., Makin-Taylor R., Hey C. Y., Toh C., Findlay J. M., Griffiths N., Ganesananthan S., Jasionowska S., Poustie M., Wong C., Turner T., Pyc W., Sloper W., Warner C., Coey J., Mason D., Sait S., Kowal M., Owen M., Saiyed A., Ashworth I., Akbari K., Curran M., Martin P., Parker D., Kwok K., Lye C., Ghaly M., Sammour T., Lewis D., Mundasad R., Wilkes A., Ctercteko G., Maslyankov S., Dimov R., Iliev S., Dimitrov D., Marek F., Orhalmi J., Skalicky P., Skalicky T., Chrz K., Christensen P., Worsoe J., Kristensen E. S., Emmertsen K. J., Loeve U. S., Mihaljevic A. L., Herrle F., Konstantinidis K. M., Korkolis D., Karanikas I., Vincenti L., Anania G., Borghi F., Agresta F., Maretto I., Parisi A., Bucci L., De Palma G., Guglielmi A., Cucinotta E., La Torre F., Cianchi F., Guerrieri M., Trompetto M., Persiani R., Micheletto G., Delrio P., Cantafio S., Ronconi M., Bisagni P. A. G., De Prizio M., Franceschi A., Galleano R., Cavallini M., Brescia A., D'Ambra L., Benevento A., Niolu P., Calgaro M., Colangelo E., Grottola T., Altomare D. F., Puleo S., Salamone G., Pietrabissa A., Poggioli G., Erdas E., Ottonello R., Tonini V., Selvaggi F., Sammarco G., Ceccarelli G., De Nisco C., Surgo D., Taglietti L., Ozolins A., Sivins A., Poskus T., Psaila J., Bemelman W. A., Graat L. J., Langenhoff B., Wijnhoven B. P. L., van de Ven A. H. W., Poelman M., Stassen L. P. S., Slooter G., Acherman Y. I. Z., Hoff C., Gerhards M. F., Stommel M. W. J., Hazebroek E. J., van Geloven A. A. W., Schasfoort R. A., van Leeuwen B. L., Tuynman J. B., van Tilburg M. W. A., Boerma E. G., Sharma P., Jenkins B., Bissett I. P., Herd A., Gordon A., Vernon D., Omundsen M., Ly J., Reddy A., Bonnet G., Harmston C., Morales M., Francisco V., Costa S., Manso A., Amorim E., Pereira J., Cardoso J., Ouro S., Caratao M., Nascimento C., Ribeiro da Silva B., Taranu V., Dias R., Mendes J., Allen M., Silva A., Carlos S., Barbosa E., Carneiro C., Ramos L., Lencastre L., Martins R., Silva-Vaz P., Ridgway P. F., McNamara D. A., Cahill R., Hogan A., Larkin J., O'Connell P. R., Negoi I., Abelevich A., Cuk V. M., Vician M., Ede C., Sardiwalla I., Mulira S., Montwedi D., Oyomno M., Sabia D., Portugal Porras V., Vigorita V., Sanz Ortega G., Garcia J., Espi Macias A., Blanco Antona F., Lujan Mompean J. A., Salvans Ruiz S., Villarejo-Campos P., Romero Simo M., Sanchez-Guillen L., Jimenez-Gomez L. M., Sanchez Lopez A., Golda T., Julia Bergkvist D., Nevado C., Noguera Aguilar J. F., cRicardo Felipe B., Septiem J., Rodriguez Sanchez A., Canete-Gomez J., Ruiz Montesinos I., Millan-Scheiding M., Prieto-Nieto I., Frasson M., Garcia Olmo D., Hubner M., Petermann D., Sauvain M. O., Ozben V., Gecim I. E., Disci E., Rencuzogullari A., Kurt A., Bisgin T., Pehlivan M., Isik A., Onur E., Leventoglu S., Haksal M. C., Erturk M. S., Keskin M., Guner A., Tutcu Sahin S., Ozbalci G. S., Pergel A., Albayrak D., Bruce D., Fearnhead N., Arthur J., Harron M., Beattie G., Titu L., Saunders M., Phillips J., Dindyal S., Cresswell B., Gercek Y., Lee J., Linn T., Faulkner G., Lockwood S., Rees J., Charalabopoulos A., Campbell B., Kontovounisios C., Amarnath T., Johnson M., Epanomeritakis E., Vigs S., Nastro P., Gilliam A., Smolarek S., Wilson T., Orbell J., McIntyre R., Agarwal T., Hainsworth P., Patel P., Vijay J., Liu B., Dhruva Rao P., Roxburgh C., Vipond M., Youssef H., Thorn C., Schizas A., Denley S., Bowley D., Das K., Cuming T., Saha A., Chung L., Pitt J., Davis P., Jones O., Taylor M., Bhargava A., Haji A., Watson N., Bloom I., Singh B., Norwood M., Gurjar S., Stylianides N., Mirza S., Evans M., Williams G., Patil P., Hernon J., Finch G., Green S., Chapple K., Fafemi O., Warusavitarne J., Samee A., Carden C., Ong L., Verma K., Joseph A., Rawat N., Pinkney T., Oke O., Glen P., Maxwell-Armstrong C., Oliphant R., Garner J., Moug S. J., Middleton S., Lund J. N., Smart N. J., Osborn G., Moore T., Raymond T., Knowles C. H., Hany T. S., Clarke R., Khera G., Brady R., Sellahewa C., Mason C., Torrance A., Lasithiotakis K., Knight J., Pullybank A., Ainsworth P., Reid F., Ramwell A., Maslekar S., George R., Skull A., Holtham S., Muhammad K., Lal R., Varcada M., Smith F. M., Howlader M., Defriend D., Kirk S., Richards T., Evans C., Borg C. M., Telford K., Sarfraz N., Busby K., Hollingshead J., Speake D., Pawa N., West D., Chadwick M., Komolafe O., Richardson S., Thornton M., Goede A., Osborne C., Bandyopadhyay D., Foong J., Lee Y. J., Liebenberg P., Mijalkov D., Wells A., Bull N., Ajmera A., Warburton T., Morgan S., Mahmoud A., Schachtel M., Mikhail B., Fomin I., Mekaeil B., Taylor N., Stevenson C., Drane A., Pahalawatta U., Lai L. T., Debiasio A., Jun H. J. S., Hengpoonthana R., Mendis D. M., Robb P. M., Lee H. J., Wyche A. A. B., Davis L. T., Chrimes A., Agarwal A., Zhao J., Williams S., Jayalath J. M. S. N., Khor S., Muddasani T., Childs S., Ridgway S., Blefari N. D. A., Tam H., Puchalski N., Ngai C., Mackenzie J., Johnson N., Holmes M., Zuzek R., Saluja T., Gould T., Goh Y. K., Selvaraj T., Beh Y. Z., Dudi-Venkata N. N., Horne D., Borrow J. L., Campbell C., Cousins G., Jackson L., Maheepala K., Zhao S., Holden E., Tutt L., Thompson B., Collins H., Louie F., Buckland B., Smith D., Chong C., Chua T. H., Nayak C., Redmond J., Tan R. R., Gramlick M., Teh J. S., Ng S. Y., Britten-Jones P., Mohd Rosli R., Pham H. D. V., Jegathees T., Coulter-Nile S. M. C. J., Gosselink M. P., Wang Y. L., Maciaszek M., Chrapko P. S., Nair A., Thirugnanasundralingam V., Muir K., Salibasic M., Pavlov V., Paycheva T., Lyulenina E., Kolev N., Nguen D., Mitkov Y., Mitkov E., Vladova P., Dimitrov V., Hussain M., Gabarski A., Ivanov T., Yotsov T., Ilieva I., Akisheva A., Shoshkova M., Nawaz E., Feradova H., Mladenov T., Jozaf V., Klail T., Pos M., Adel A., Sotona O., Bartos M., Amjad T., Maly O., Berec S., Hanusova M., Hurny M., Risko J., Ludvik M., Stercz M., Treskon R., Pospisil M., Hlavacova L., Tomanova D., Chodora S., Houdek O., Novicky R., Sobotkova K., Cha S., Suta Kimle K., Jirankova K., Bujda M., Paclik A., Trap A., Jurgens-Lahnstein J., Storm M., Damgaard I., Olawi F., Ehlern F., Raos M., Kristensen F. P., Bonnerup K., Amiri S., Enevoldsen M., Hojgaard Pedersen J., Jepsen B. N., Hillgaard T. K., Erichsen S. B., Nielsen C. V., Madsen C. P., Bjerke J., Skejo C. D., Aabling R. R., Sorensen J. S., Turunen A., Katunin J., Niskakangas M., Vignaud T., Frey S., Ricolleau C., Chanut F., Magnin J., Seiboldt T., Beck L., Zamzow K., Betge F., Poncelet A., Truant M., Hauschild H., Neugebauer N., Schoning L., CS Simon S., Galata C., Karampinis I., Thawel T., Seckler A. M., Kerem C., Durdevic S., Antonakopoulos F., Mathioulaki A., Chrysoheris P., Athanasopoulos P. G., Kalles V., Spyrou I., Barkolias C., Paspala A., Papaconstantinou D., Spartalis E., Arkadopoulos N., Prodromidou A., Garoufalia Z., Mendez D., Rosales J., Flores M., Garcia M., Garcia A., Noriega Z., Torselli D., Rodriguez J., Lafranceschina S., Artioli E., Giaccari S., Nevoso V., Schimera A., Marino S., Geretto P., Pellegrino L., Borghi B., Marano A., Corino C., Cannata G., Giuffrida M. C., Landra F., Ongaro D., Baronio G., Raimondo S., Casiraghi S., Salvadori R., Finotti E., Ciccioli E., Galgano A., Zuin M., Bettella A., Barina A., Vendramin E., Palano G., Schiavone D., Di Cintio A., Gemini A., Trastulli S., De Luca M., Desiderio J., Gubbiotti F., Cigognini M., Zaffaroni G., Maffioli A., Colombo S., Bondurri A., Sampietro G., Foschi D., Manigrasso M., Danzi M., Amato R., Anastasio L., Mastella F., Basile R., Peltrini R., Marra E., Luglio G., Giglio M., Anoldo P., Vertaldi S., Grimaldi L., Tammaro N., Pedrazzani C., Turri G., Lazzarini E., Conti C., Vulcano I., Bertilone E., Pintabona G., Viscosi F., Cerasari S., Galiffa G., Lapolla P., Del Basso C., Cirillo B., De Toma G., Fazzi K., Bini S., Coratti F., Montanelli P., Grandi S., Nelli T., Ben Khaled N., Cammelli F., Ferrini E., Billo M. E., Marrosu A. G., Scognamillo F., Pala C., Attene F., Carboni L., Ruggiu M. W., Gabbas G., Marziali I., Mazzocato S., Vergari R., Piazzai F., Kubolli I., Aggiusti A., Paolucci A., Ortenzi M., Olivieri M., Belluco C., Antona A. D., Basso S., Morino M., Mistrangelo M., Clerico G., De Santi G., Bitonti M. F., Frattalone M., Fico V., Santullo F., Belia F., Spinelli A., Marco M., Bevilacqua M., Tringali D., Bevilacqua E., Panizzo V., La Manna V., Migliore G., Aversano A., Fares Bucci A., Marino F., Carbone F., Incollingo P., Romano F. M., Zalla T., Baraghini M., Romoli L., Calussi M., Vellei S., Genzano C., Feroci F., Vita M., Barberis A., Serra D., Grassia M., Romelli M., Ruggiero S., Percassi A., Magri Piccinini A., Monti M., Magnoli M., Romano S., Gaetano P., Pilotta F., Baldassarre L., Bonati E., Aresu S., Saba A., Moretto G., Bacchion M., Casaril A., Inama M., Creciun M., Stella M., Gobatti D., Angelini M., Andolfi E., Miranda E., Scricciolo M., Provenza G., Cavallina G., Frezza B., Fontani A., Malatesti R., Pellicano G. A., Anania M., Pulighe F., Cruccu A., Murru M. L., Massaiu C., Balestra F., Pazzona M., Giannella A., Santangelo M., Frangella F., Magagnano D., Liberatore P., Brenna R., Giani A., Tirotta F., Famularo S., Angrisani M., Ceresoli M., Rondelli F., Angelucci G. P., Scaramuzzo R., Larcinese A., Fioriti C., Picone E., Nardi M., Castagnoli G., Bartoli A., Bellochi R., Spaziani A., Conti D., Poponesi V., Trippetti M., Amicucci S., Tazza G., Procacci P., Giovannini F., Basile E., Caristo G., De Nardi P., Rosati R., Marcocci G., Vignali A., Malerba M., Percivale A., Ghazouani O., Reggiani L., Spirito C., Moschetta G., Cosmi F., Romeo G., Gasparrini M., Sucameli F., Gennai A., Moggia E., Bianchi C., Bonfante P., Macina S., Feleppa C., Imperatore M., Tenconi S. M., Rausei S., Maioli D., Marchionini V., Sparta C., Mura F. A., Barmina M., Lorettu A., Rettaroli C., Mastino G., Ruggiu G. V., Mura G. A., Perrone B. A., De Angelis M., Mereu A., Adamo V., Bianco C., Ricciardiello M., Campanaro C., Panaccio P., Esposito L. M., D'Ascanio F., Pietroletti R., Chetta N., Aquilino F., Di Marco F., Amico A., Schembari E., Puglisi S., Licari L., Campanella S., Profita G., Falco N., Rotolo G., Venturelli P., De Marco P., Marciano M., Argenti F., Milani M. S., Malabarba S., Giambartolomei G., Vella I., Gronchi F., Ruggieri A., Roggiani A., Balsamo F., Gori A., Cuicchi D., D'Alessio R., Benvenuto D., Podda F., Cappellacci F., Salaris C., Sanna S., Marcialis J., Mosino L., Peddis M., Melis S., De Donno G., Aru A. C., Falsetti E., Lanari J., D'Errico U., Bianchini S., Figa F., Caiazzo A., Selvaggi L., Capozzolo A., Cerra C., Pirillo M., Cravano S., Libri I., Laquatra N., Isabello A., Truskovs A., Bartnick A., Malcevs E., Machatschek M. J., Alm J., Lapsa S., Delorme M., Zeynalov F., Larnovskis J., Sauka J., Bodrov D., Gailumsis R., Wiemann A. M., Muller N. L., Jelovskis I., Deksnis D., Bauermeister Potts O., Slimbajevs T., Samalavicius N. E., Nutautiene V., Zeromskas P., Jurgaitis J., Aliosin O., Slepavicius A., Eismontas V., Kybransiene M., Dulskas A., Kuliavas J., Kavaliauskas P., Kavaliauskaite R., Poskus E., Danys D., Kryzauskas M., Mikalauskas S., Rackauskas R., Drungilas M., Jotautas V., Strupas K., Cachia C., Cefai C., Youssef Y., Degaetano D., Debono S., Sammut M., Cassar J., Sammut K., Looijen R. C., Becker M. A. J., Comert D., te Molder L., Tromp J., Matthee E., Tissen Y. M., Brinkhuis E., de Vries H. S., 't Hart E., Beckers K., Bekker Y., Kakar S., van Smaalen T. C., Veen O. C., Dingemans S. A., van den Brink L. C., Vijgen G. H. E. J., van de Voort E. M. F., van der Pool A., van Rest K. L. C., Haak T., Sluijpers N. R. F., Molenaar C. J. L., Gordinou de Gouberville M. C., Saleh S., Mens M. A., Hoeks E. M., Nieuwenhuizen S., van Praag E. M., Westerduin E., Smit M. P. C. M., van der Lely S. J., Nasimi B., Gerdsen M., Stijns R. C. H., Leow T. Y. S., Penningnieuwland G., de Ruiter A., Ribbers T., Aarts C. A. M., Tulek M. S., de Jonge J., Kocak S., Alqethami H. J., Constansia R., van Elst P. C., Tissink M. W., Gruter A., Vroom Y., Voeten D. M., Feenstra T., Azzahhafi J., Bofarid S., Kip M., Saleh W., Franssen S., Boon C. L., Franssen R. J. M., Romaen I., Jense M. T. F., D'Souza J., Pascoe R., Scott A., Stark E., Mulholland K., Lau W. K., Smith B., Adams S. I. B., Shah N., Ling E., Young J., Jacobson A., Macfater H., Chen S. Y., Kilpatrick K., Kim D. H., Dixon S., Yassaie S., Welman D., Coulter J., Morreau M., Li E., Rankin A., Winders J., Skipworth C., Stanfield B., Henderson N., Chuang A., Maskill L., Ker H., McLaughlin S. J. P., Kearney J., Sprosen H., Kerckhoffs P., Alsadat R., Cherry R., Chapman D. A., Singh N., Clucas A., Gatenby G., Kelly B., Ruppeldt P., McIntosh N. D., Koh S., Wilms H., Dalzell F., Tewhaiti-Smith J., Kader T., Yam S. 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F., Parreira R., Faustino A., Medeiros N., Castro R., Soares B., Resendes M., Almeida P., Cruz A., Vaz Pinto G., Sousa D., Costa Santos D., Silva F., Fialho G., Reia M., Pratas N., Costa C., Costa J., Morais S., Machado A., Horta V., Rocha-Melo M., Patricio J., Pereira M., Lima R., Cinza A. M., Oliveira J., Velez C., Borges F., Simoes J., Botelho P., Cismasiu B., Alves D., Dias B., Goncalves J. P., Valente P., Freire L., Saraiva R., Moreira M., Fragoso M., Guimaraes J., Cruz G., Ribeiro J., Borges da Ponte I., Almeida S., Martins A. R., Louro T., Morgado M., Ferreira A. S., Alves M., Oliveira N., Lerias R., Estalagem I., Botelho C., Bartolo J., Fidalgo Antunes C., Cabral F., Brito Silva F., Dias Matos A., Santos M., Cunha R., Sousa M., Canotilho R., Correia A. M., Martins P. C., Jardim J. A. M., Domingos S. P., Baiao J. M., Rocha B. S., Lopes N. M. R. O., Jordao D. M., Angelo M. D., Caroco T., Gomes J. R., Monteiro R. G., Varghese S., Boyle E., Aljohmani L., Alexander J., Graziadei V., McCaughey C., Jain A., Ramanayake H., Sabnani R., Colon L. F., Bansal N., Stephens I., Tan R., Sharma S., Doherty G., Fenn S., Mulhare E., Walsh M., Leavey C., Costigan O., Griffin S., Dockry E., Khogali E., Aly A. K., McPhedran R., O'Gorman D., Vermeulen D., Dervan L., Kang S. J., Dixon O., Morrissey E., Compton M., Pentony A. R., Piong C. L., Nossier R., Hanna J., Sabir K., Eow S. Y., Ladak N., Boersma D., Kamath P. J., Soh T. B. W., Dyer A. H., Chee S. Y., Tan I. X. H., Kelliher A., Adeusi L., Howarth N., McCawley N., O'Neill A., Jones M. R., Saleh R., Singh A., Senaratne R., Kakodkar P., Balasubramanian I., Al-Salihi A., Vyas V., Vedadi A., Popescu S. S., Piras K., Ciubotaru C. I., Romanova E., Ponomarev N., Savchenko A., Luzan R., Lutovinova E., Gavrilina A., Barkovskaya A., Kudelkina N., Topchubaev D., Radulovic R., Milosevic K., Bojicic J., Gencic M., Jankovic U., Zubowicz M., Suchan P. K., Gerstmeier J., Brazitikou E., Fytrou E., Celik M., Dubovsky M., Schmalenbeck J., Sautter S. C., Ceyran H., Fitchat N., Mathebula S., Chauke J., Mculu W., Ngwenya Z., Withey K., Piperidis A., Toyi Y., Nicolaides A., Jaffer T., Sparke A., Van Staden N., McDuling C. R., Claassen L., Kruger C., Weyers J., Lecler J., Yebes A., Mana O. C., Gomez H., Riba L., Perez J., Casaval Cornejo L., Vicente Rodriguez I., Jimenez Escovar F., Calvo Fernandez M., Portugal Martinez A., Badiola Bergara I., Landaluce Olavarria A., del Pozo Andres E., Samartin Toimil C., Primo Alvarez J. C., Rodriguez Fernandez L., Ortega C., Ossola M. E., Camarero E., Martinez Illan M., Aranda Garcia L., Lazaro Cardona M., Montalvo Olmedo C., Livianos Arias-Camison P., Nieto Arranz J. M., Mateos Sexmero M. J., Diego Alonso E., Izquierdo Moreno A., Margarida A., Pando B., Liquete Marin L., Perez Calle M., Ramos Cordero M. J., Sagredo Cuartango A., Sanchez E., Marcos Rodrigo A., Martinez Diaz J. M., Ruiz Manzanera J. J., Navarro Barrios A., Rodriguez Pedreno L., Garcia Moreno P., Garcia Gomez M., Rodrigues K., Platero Diago J., Veras Lista M., Rifa Terricabras S., Butler Sanz L., Alberch Camprubi E., Rico Ferrandez M., Puig Lao E., De Pablo Miro M., Alberca-Paramo A., Alia Verdejo T., Canete-Manzanares J., Molina-Florez M., Garcia Hernandez L. C., Orozco Nunez S., Suarez-Sanchez M., Martin-Fernandez J., Soriano Liebana M. M., Campo Betancourth C. F., Sevila Mico S., Fernandez A., Curtis C., Bosch M., Triguero D., Bosch Ramirez M., Ramayo Diaz N., Gonzalez Caraballo I., Pascual Vicente T., Orue-Echebarria M. I., Sanchez-Calvo L., Wang D., Trueba-Collado C., Morales Bernaldo de Quiros J. T., Lima Pinto F., Nunez OSullivan S., Ramos Jimenez F. A., Perez Ortega A., Trujillo Barbadillo A., Romero Pujana E., Fernandez Illera M. V., De La Llave Serralvo A., Mestres N., Cuello E., Merichal M., Sierra J. E., Escoll J., Rufas M., Pinillos A. I., Ortega J., Vivas Angeles P., Vives Figueras R., Baena Sanfeliu E., Campillo Alonso B., Alberich Prats M., Duran Arrocha J., Cornella Garceso N., Uribe Galeano C., Delisau Puig O., Castro A., Codony Bassols C., Fernandes N., Garcia Adamez J., Caula Freixa C., Sanchez M. J., Martin-Borregon P., Quevedo A., Martinez J., Marin J. M., Rodriguez P., Garcia Orozco J. J., Ferrusola Diaz D. A., Garcia Jimenez M. L., Castro Diez L., Mosquera Fernandez C., Alonso Batanero E., Cifrian Canales I., Calzada M. G., Recuenco C. B., Martin M. C., Esteban Avendano I., Jimenez Relimpio C., Lancho Lavilla P., Blanco Bartolome I., Gomez Cano I., Blasco Andres C., Alonso-Poza A., Dieguez B., Losada M., Gilsanz C., Garcia-Vico A., Roman-Rando A., Sanchez-Galvez M. A., Bersabe-Alonso I. M., Vadillo-Bohorquez A., Gutierrez Rios R. D., Eizaguirre Ubegun M., Novo Sukia I., Uribe Isado M., Ibanez Alda M., Pastor Idoate C., Abad-Motos A., Marinez-Hurtado E., Salvachua-Fernandez R., Padilla Zegarra E. D., Franco M., Martinez A., Ramos Martin P., Mate Mate P., Marcano Chavez C., Ayllon H., Jeri-McFarlane S., Soldevila-Verdeguer C., Pineno-Flores C., Ambrona-Zafra D., Fernandez-Vega L., Gil-Catalan A., Craus-Miguel A., Pujol-Cano N., Sena-Ruiz F., Gomez Jurado M. J., Alberti Delgado P., Bordanova Reverter A., Belzunce-Capo J. F., Verdaguer Tremolosa M., Lin Q., Muniesa C., Avelino L., Cholewa H., Sancho-Muriel J., Navasquillo M., Navio A., Abello D., De Jesus M., Alvarez E., Garcia J. M., Gil A., Giordano H. E., Mignon G., Vanoni A., Henkens A., Jarrar G., Odovic M., Willemin M., Milliet O., Hahnloser D., Demartines N., Teixeira H., Pittet O., Haller M. L., Huot A., Kefleyesus A., Bugmann A., Piotet L. M., Meijers L., Kurtoglu G. K., Sel E. K., Isler V. C., Yilmaz B. S., Adiyaman C., Kara M., Demirkaya H. C., Korkmaz H. K., Pektas A. M., Guner B., Islek E. C., Tombul H. B., Boztug C. Y., Tinaz A., Yilmaz M., Karaman Y., Akin F. A., Dansuk S., Bascavus M., Kaya M., Kutlu B., Seker M. 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H., Alawattegama H., Seite E., Barrett A., Riordan E., Lam W., Dowdeswell M., Mulvenna C., Awokoya O., Gurowich L., Dhera K., Hayat S., Tincknell L., Spazzapan M., Teeling F., Sysum K., Latter J., Latter M., Khan S., Guruswamy M., Beedham W., Brazier E., Elghobashy M., Bajaj M., Mann H., Etel E., Woodmass M., Hayden H., Ali Y., Husain S., Arnold A., Pedersen A. C., Cunha P., Ahmed M., Al Zawawi S., Kudva V., Theodoropoulou K., Miscampbell M., Robinson A. V., Johnston J., Dharni A., Lamb S., Westerman T., Evans E., Campbell L., Gillespie M., Cheong C. M., Kulathevanayagam K., Varghese A., Ike S. I., Chu T. S. M., Baljer B., Mogg J. A. W., Rai P., Claireaux H. A., Williams M., Smillie R., Goetz J., Appleby E., Fadipe T., Vaughan-Burleigh S., Puri G., Hussain P., Flather R., Cutler A., Pathak S., Sheldon J., Collicott T., al-Ausi M., Jovaisaite A., Shah S. M., Khalid N., Gutmann D., Davison S., Alame Y. J., Syed L., Owen W. J., Ahsan S. D., Anthony-Uzoeto U., Macleod Hall C., Zheng S., Wynter K., James C., Sapre D., Ghosh R., Baird J., Cockburn L., Blackwood O., Simpson W., Jeong S., Bishop S., Bate R., Hobson C., Adam A. H., Redclift C., Do J., Adeleye O., Poli F., Batterham A., Brown S., Parekh J. N., Clay W., Pieri K., Jackson A., Saxena A., Gurung B., Oyebola T., O'Brien F., Djeugam B., Gardezi S., Ul-Hasan S., Martin-Hernandez M. P., Sisley M., Modi S., Antakia R., Elbayouk A., Soh Y. J., Mather J., Yusuf Z., Al-Sarraf Z., Naja M., Rassool S. B., Convill J., Nikookam Y., Warsame A., Pace C., Kiandee M., Ridwan R., Carey C., Hirri F., McMillan M. J. A., Ling J. J., Pendelbury L., Kerimzade K., Tang A., Howard E. O., Humayun S., Wadsworth O. J., Tan K., Abdelhameed F., Haglund C., Radnaeva I., Hu N., Rambhatla S., Waldron D., Madahar P., Malik S., Meney L. C., Ibrahim I., Kang C. K., Chiu J. Z. J., Livie V., Ibrahim B., Khalil M., Pooley G., Shishkin B., Docherty J., Southgate A., Coomes A., McGee F., Flanagan S., Tan Q. J., Anwar H., Clough R., Chrisp B., Cassels J., Cross G. W. V., Mercer L., Mercer C., Refalo A., Hadley R., McTighe A., Farrow F., Brodie A., Davis G., Shah D. R., Bowers C., Patel S., Morice O., Burzic A., Cheung J., Shashidhara A., Theodoraki G., Birk J., Ong A., Ng M. P. E., Wong R. T. W., Maese S., Yeap B., Iqbal Z., Rojoa D. M., Cabaleiro Barciela C., Ruddy C. M., Lindwe S., Qamar Y., Chuita S., Melaugh T., Hall J. D., Kouli O., Hassane A. S. I., Azhar A. W., Tan T. K., Perchard W., Scurr T., Campbell E., Kelk L., Ghosh A., Gibbins A., Mala D., Loizidou A., Hall O., Mecia L., Hew C., Varathan K., Tong L., Chandrasekar B., Buchanan E., O'Connell M., Kwak S. Y., Ong E. H., Gardner S., Lim J., Maden C., Illahi M., Xuan Tan Z., Stahl R., Stahl J., Hickman A., Collett D., Goolam-Mahomed Z., Allen B., Atiyah A., Ahmad H., Jones J., McGregor O., Ogundiya E., Boulbadaoui A., Kirnon-Jackman O., Lim Q. X., Peckham H., Yeoh T., Yong S. Q., Chen J. Y., Siva S., Sam Z. H., Gilani M., Goh Y. N., Muthukumar M. G., Phillips S., Tjoakarfa J., Giri A., Suresan S., Thomas P., Johnson T. A., Williams R. I., Rashid A., Kushairi A., Rais A., James A., Bugelli M., Chechelnitskaya Y., Sandhu N., Tandon R., Gray M., Kumar A., Ciurleo C., Nyamali I., Hiremath S., Sinha S., Chowdhary M., Bradley E., McTiernan M., Macdonald S., Sharkey S., McLaughlin N., Amey C., Kraria L., Skan O., Kind C., Tupper P., Van Rhee C., Honeyman S. I., Menon G., Jegatheeswaran L., Madhavan A., Warne M., Malcolm F. L., Lessware T., Wilkerson H. T., Chatterjee-Woolman S., Yoong A., Ahmed W. U. R., Longshaw A., Flannery O., Green R., Leaning M., Cragg J., Sharriff H., Doherty C., Kwan K. W. L., Sanders-Crook L., Bhatia S., Eames S., Lewis F., Kirupananthan P., Boh Z. Y., Dass S., Soma A., Newton A., Hill M., Shafiq Y., Brkljac M., Boyce L., English W. J., Lam S., Chipeta C., Jain C., Garofalidou T., Novotny S. A., Locke S., Bowman C., Begaj A., Murphy C., Radcliffe K., Chong J. T., Jeffrey E., Chaudhury N., Rajendran K., Akbar Z., Walters B., Kulendrarajah B., Tran N., Shrestha S., Parmar S., Gallagher C., Hennessy L., Pentti E., Badhrinarayanan S., Fung A., Mansoor M., Kenny R., Kan P., Lee D. E., Khosla S., Samake M., Shaban F., Aftab R., Gough M., Woodburn B., Vayalapra S., McMurrugh K., Jimulia D., Deol S., Pike S., Embury-Young Y., Patel M., Kilgallon E., Keating R., Walsh A., Khan H., Logue G., Orekoya M., Alasmar M., Charalambides M., Clave Llavall A., Williamson E., Bharwada Y., Zearmal S., Evans H., Panikkar M., de la Cruz G., Caplan J., Ruparelia A., Tanvir T., Soare C., Pang Y. 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T., Wynell-Mayow W., Udayachandran V., Alsoof D., Ekert J., Joseph N., Zulkefley N., Hunt G., Christodoulou T., Wright O., Soman S., Jamal M., Beqiri S., Borgas P., Christie S., Pereira F., Browne S., Yiu J., Dworkin A., Brayley J., Palmer A., Charalambos M., Jones C. S., Toner S., Cowden R., Lee L., Nicol P., Holman O., Imtiaz M., Albert V., Leung S. P., Erotocritou M., Stroud R., Wilkin R., Thomson W., Mackee L., G N., Bei Y., Mckenna Favier S., Ibrahim A., Kler A., Reynolds L., Mohamed S. H., Majeed Y., Fakim B., Jones A., Liversedge G., Carrington Z., Windebank J., Izzarina A., Akbani U., Craven J., Aldarragi A., Harding S., Millward A., Bedford M., Gopalan V., Midgen A., Khadka P., Cheng O., Taneja S., Manobharath N., Kok J. Y., Lim D. W. E., Buick T., Boland M., Piya S., Devlin R., Fairfield C. J., George R. J., Rahi M., Zaman S., Hajiev S., Ross T., Crisp E., Thompson C., Charalambous A., Hollywood J. L., Hammond R. F. 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H., Thomas G., Brandsma A. M., Davids J., Rottier S. J., de Roy van Zuidewijn D., Hawkins R., Ong H. I., Li Y., Desmond B., Winstanley J., Martins M., Americano M., Frade S., Senhorinho R., Peixoto R., Alves-Vale C., Lamas M., O'Connor D. B., Hoo M., Gopaul A., Scanlon K., O'Dwyer N., Jovanovic M., Panyko A., Van Vuuren S., Centeno A., Bernado I. R., Paniagua Garcia Senorans M., Gonzalez Amor L., Cuenca Ramirez A., Abrisqueta J., Estaire Gomez M., Arroyo A., Cerdan C., Gomez Romeu N., Enriquez-Navascues J. M., Collado-Roura F., Curchod P., Gaspar S., Imadalou L., Mutlu D., Akyol C., Uygur F. A., Eray I. C., Biyiklioglu O., Cetin M. F., Isik A. E., Karip B., Dogan H., Sarigul L., Tunc E., Aydin T., Bodur S., Karabulut K., Francis A. A., Al-hadithi A., To N., Lau I. S. F., Smith E., Mahapatra S., McAuliffe O., Imam L., Akram B., Hossaini S., Davies R., Ko M., Collins J., Pandya A., Reilly S., Archer J., Auty C., Roche C. D., Livie J., Chaudhry F. 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Ede C., Sardiwalla I., Mulira S., Montwedi D., Oyomno M., Sabia D., Portugal Porras V., Vigorita V., Sanz Ortega G., Garcia J., Espi Macias A., Blanco Antona F., Lujan Mompean J.A., Salvans Ruiz S., Villarejo-Campos P., Romero Simo M., Sanchez-Guillen L., Jimenez-Gomez L.M., Sanchez Lopez A., Golda T., Julia Bergkvist D., Nevado C., Noguera Aguilar J.F., cRicardo Felipe B., Septiem J., Rodriguez Sanchez A., Canete-Gomez J., Ruiz Montesinos I., Millan-Scheiding M., Prieto-Nieto I., Frasson M., Garcia Olmo D., Hubner M., Petermann D., Sauvain M.O., Ozben V., Gecim I.E., Disci E., Rencuzogullari A., Kurt A., Bisgin T., Pehlivan M., Isik A., Onur E., Leventoglu S., Haksal M.C., Erturk M.S., Keskin M., Guner A., Tutcu Sahin S., Ozbalci G.S., Pergel A., Albayrak D., Bruce D., Fearnhead N., Arthur J., Harron M., Beattie G., Titu L., Saunders M., Phillips J., Dindyal S., Cresswell B., Gercek Y., Lee J., Linn T., Faulkner G., Lockwood S., Rees J., Charalabopoulos A., Campbell B., Kontovounisios 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Thompson B., Collins H., Louie F., Buckland B., Smith D., Chong C., Chua T.H., Nayak C., Redmond J., Tan R.R., Gramlick M., Teh J.S., Ng S.Y., Britten-Jones P., Mohd Rosli R., Pham H.D.V., Jegathees T., Coulter-Nile S.M.C.J., Gosselink M.P., Wang Y.L., Maciaszek M., Chrapko P.S., Nair A., Thirugnanasundralingam V., Muir K., Salibasic M., Pavlov V., Paycheva T., Lyulenina E., Kolev N., Nguen D., Mitkov Y., Mitkov E., Vladova P., Dimitrov V., Hussain M., Gabarski A., Ivanov T., Yotsov T., Ilieva I., Akisheva A., Shoshkova M., Nawaz E., Feradova H., Mladenov T., Jozaf V., Klail T., Pos M., Adel A., Sotona O., Bartos M., Amjad T., Maly O., Berec S., Hanusova M., Hurny M., Risko J., Ludvik M., Stercz M., Treskon R., Pospisil M., Hlavacova L., Tomanova D., Chodora S., Houdek O., Novicky R., Sobotkova K., Cha S., Suta Kimle K., Jirankova K., Bujda M., Paclik A., Trap A., Jurgens-Lahnstein J., Storm M., Damgaard I., Olawi F., Ehlern F., Raos M., Kristensen F.P., Bonnerup K., Amiri S., 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E., Ciccioli E., Galgano A., Zuin M., Bettella A., Barina A., Vendramin E., Palano G., Schiavone D., Di Cintio A., Gemini A., Trastulli S., De Luca M., Desiderio J., Gubbiotti F., Cigognini M., Zaffaroni G., Maffioli A., Colombo S., Bondurri A., Sampietro G., Foschi D., Manigrasso M., Danzi M., Amato R., Anastasio L., Mastella F., Basile R., Peltrini R., Marra E., Luglio G., Giglio M., Anoldo P., Vertaldi S., Grimaldi L., Tammaro N., Pedrazzani C., Turri G., Lazzarini E., Conti C., Vulcano I., Bertilone E., Pintabona G., Viscosi F., Cerasari S., Galiffa G., Lapolla P., Del Basso C., Cirillo B., De Toma G., Fazzi K., Bini S., Coratti F., Montanelli P., Grandi S., Nelli T., Ben Khaled N., Cammelli F., Ferrini E., Billo M.E., Marrosu A.G., Scognamillo F., Pala C., Attene F., Carboni L., Ruggiu M.W., Gabbas G., Marziali I., Mazzocato S., Vergari R., Piazzai F., Kubolli I., Aggiusti A., Paolucci A., Ortenzi M., Olivieri M., Belluco C., Antona A.D., Basso S., Morino M., Mistrangelo M., 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Rondelli F., Angelucci G.P., Scaramuzzo R., Larcinese A., Fioriti C., Picone E., Nardi M., Castagnoli G., Bartoli A., Bellochi R., Spaziani A., Conti D., Poponesi V., Trippetti M., Amicucci S., Tazza G., Procacci P., Giovannini F., Basile E., Caristo G., De Nardi P., Rosati R., Marcocci G., Vignali A., Malerba M., Percivale A., Ghazouani O., Reggiani L., Spirito C., Moschetta G., Cosmi F., Romeo G., Gasparrini M., Sucameli F., Gennai A., Moggia E., Bianchi C., Bonfante P., Macina S., Feleppa C., Imperatore M., Tenconi S.M., Rausei S., Maioli D., Marchionini V., Sparta C., Mura F.A., Barmina M., Lorettu A., Rettaroli C., Mastino G., Ruggiu G.V., Mura G.A., Perrone B.A., De Angelis M., Mereu A., Adamo V., Bianco C., Ricciardiello M., Campanaro C., Panaccio P., Esposito L.M., D'Ascanio F., Pietroletti R., Chetta N., Aquilino F., Di Marco F., Amico A., Schembari E., Puglisi S., Licari L., Campanella S., Profita G., Falco N., Rotolo G., Venturelli P., De Marco P., Marciano M., Argenti F., Milani M.S., Malabarba S., Giambartolomei G., Vella I., Gronchi F., Ruggieri A., Roggiani A., Balsamo F., Gori A., Cuicchi D., D'Alessio R., Benvenuto D., Podda F., Cappellacci F., Salaris C., Sanna S., Marcialis J., Mosino L., Peddis M., Melis S., De Donno G., Aru A.C., Falsetti E., Lanari J., D'Errico U., Bianchini S., Figa F., Caiazzo A., Selvaggi L., Capozzolo A., Cerra C., Pirillo M., Cravano S., Libri I., Laquatra N., Isabello A., Truskovs A., Bartnick A., Malcevs E., Machatschek M.J., Alm J., Lapsa S., Delorme M., Zeynalov F., Larnovskis J., Sauka J., Bodrov D., Gailumsis R., Wiemann A.M., Muller N.L., Jelovskis I., Deksnis D., Bauermeister Potts O., Slimbajevs T., Samalavicius N.E., Nutautiene V., Zeromskas P., Jurgaitis J., Aliosin O., Slepavicius A., Eismontas V., Kybransiene M., Dulskas A., Kuliavas J., Kavaliauskas P., Kavaliauskaite R., Poskus E., Danys D., Kryzauskas M., Mikalauskas S., Rackauskas R., Drungilas M., Jotautas V., Strupas K., Cachia C., Cefai C., Youssef Y., 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S.I.B., Shah N., Ling E., Young J., Jacobson A., Macfater H., Chen S.Y., Kilpatrick K., Kim D.H., Dixon S., Yassaie S., Welman D., Coulter J., Morreau M., Li E., Rankin A., Winders J., Skipworth C., Stanfield B., Henderson N., Chuang A., Maskill L., Ker H., McLaughlin S.J.P., Kearney J., Sprosen H., Kerckhoffs P., Alsadat R., Cherry R., Chapman D.A., Singh N., Clucas A., Gatenby G., Kelly B., Ruppeldt P., McIntosh N.D., Koh S., Wilms H., Dalzell F., Tewhaiti-Smith J., Kader T., Yam S.T., Dahya D., Hardie Boys M., Fleischl W., Skavysh A., Mouldey K., Hu R., Edwards S., Matthews C., Aitken E., Walker M., Tome M., Patrocinio S., Amado F., Batista A., Seabra J., Praxedes V., Monteiro N., Martins I., Santos T.C., Lages R.R., Pimentel A., Sa T., Bernardes F.M., Saraiva P., Almeida J., Mendes M., Fernandes V., Ribeiro A., Soares D., Martins T., Miguel I., Martins J., Cunha M.F., Melo J., Veiga D.N., Rachadell J., Vareda R., Roseira J., Aveiro D., Couto M., Loureiro A.R., Louro H., Queiros T., Castro B., Fonseca S., Carvalho L., Torre A.P., Amado A., Leite M., Miranda P., Cunha C., Silva R., Pina S., Paixao I., Orelhas L., Santos J., Pacheco A., Rocha A.F., Jervis M.J., Pedro V., Paixao V., Guerreiro A., Melo D., Correia D., Capella V., Moinhos T., Silva M., Silva A.G., Galvao D., Mora A., Bettencourt R., Costa F., Gil I., Morgado J., Monica I., Oliveira S., Ribeiro H., Guimaraes N., Duarte M., Miranda J., Martins S.F., Parreira R., Faustino A., Medeiros N., Castro R., Soares B., Resendes M., Almeida P., Cruz A., Vaz Pinto G., Sousa D., Costa Santos D., Silva F., Fialho G., Reia M., Pratas N., Costa C., Costa J., Morais S., Machado A., Horta V., Rocha-Melo M., Patricio J., Pereira M., Lima R., Cinza A.M., Oliveira J., Velez C., Borges F., Simoes J., Botelho P., Cismasiu B., Alves D., Dias B., Goncalves J.P., Valente P., Freire L., Saraiva R., Moreira M., Fragoso M., Guimaraes J., Cruz G., Ribeiro J., Borges da Ponte I., Almeida S., Martins A.R., Louro T., Morgado M., 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Nair M., Aly M.H., Buari M., Ahmed K., Sheikh Z., Monks M., Lehmann J., Rotimi O., Bell T., Limnatitou D., Gormley S., Taleongpong P., Patel V., Macgregor L., Amini S., Turner C., Dwyer-Hemmings L., Busuttil A., Powell J., Hensher C., Vivian F., Wcislo K., Millar Z., Hirosue S., Ogunmwonyi I., Nakakande D., Gaze H., Nirmalanantha A., Bin Amran M.A., Foulkes A., Jones N., Pillai S., Khoury G., Powell T., Maleyko I., Sangheli A., Ransome M., Isse M., Aromolaran O., Bholah H., Anbarasan J., Rehman S., Hu E., Timms S., Reynolds W., Hotchkies A., Misra V., Theocharidou L., Malik T., Janmohamed I., Carhart B., Khan A., Hullait R., Rylance A., Butt S., Leathes J., Philip Rajathasan T., Jeddy H., Kyaw H.A., Wong N., Karelia S., Clements J.M., Rainey M., Joshi N., Rahman A., Gallagher M., Rebuffa N., Abdelgalil R., Siaw Yen Lai R., Laurence N., Thomas S., Green C., Frostick R., Khera R., Povey M., Wong H.L., McCusker C., Hlukha L., Pike G., Kamel F., Thakkar R., Donaldson C., Sequeira Campos 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M., Njoku P., Morris D., Jobson J., Chowdhury H., Alawode D.O.T., Wynell-Mayow W., Udayachandran V., Alsoof D., Ekert J., Joseph N., Zulkefley N., Hunt G., Christodoulou T., Wright O., Soman S., Jamal M., Beqiri S., Borgas P., Christie S., Pereira F., Browne S., Yiu J., Dworkin A., Brayley J., Palmer A., Charalambos M., Jones C.S., Toner S., Cowden R., Lee L., Nicol P., Holman O., Imtiaz M., Albert V., Leung S.P., Erotocritou M., Stroud R., Wilkin R., Thomson W., Mackee L., G N., Bei Y., Mckenna Favier S., Ibrahim A., Kler A., Reynolds L., Mohamed S.H., Majeed Y., Fakim B., Jones A., Liversedge G., Carrington Z., Windebank J., Izzarina A., Akbani U., Craven J., Aldarragi A., Harding S., Millward A., Bedford M., Gopalan V., Midgen A., Khadka P., Cheng O., Taneja S., Manobharath N., Kok J.Y., Lim D.W.E., Buick T., Boland M., Piya S., Devlin R., Fairfield C.J., George R.J., Rahi M., Zaman S., Hajiev S., Ross T., Crisp E., Thompson C., Charalambous A., Hollywood J.L., Hammond R.F.L., 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Chapman, S.J., Glasbey, J.C., Sgrò, A., Bath, M.F., Yasin, I.H., Žebrák, R., Larsen, H.M., Rädeker, L., Frey, P.E., Italia, I., van Elst, T.R., Fagan, P., Wells, C.I., Alagoa João, A., Pérez-Ajates, S., Yagız Sen, A., Aktas, M.K., Baki, B.E., Yüksek, B., Khaw, R.A., Ablett, A.D., Khan, S.M., Manley, L.R., Tan, H.L., Rye, D.S., Norman, J.G., Baker, D.M., Brandao, B.D., Onafowokan, O.O., Shortland, T.C., Brumfitt, C.D., Luong, J.K., Kunčarová, K., Kološová, B., Farkašová, M., Harbjerg, J.L., Kjaer, M.D., Unbehaun, K.P., Lycke, K.D., LeNaoures, P., Pohl, L.J., Christodoulou, I.M., Manatakis, D.K., Aguilera, M.L., Lo Conte, A., Pipitone Federico, N.S., Tilocca, P.L., Piozzi, G.N., van Wijnbergen, J., Dinger, T.L., Ten Doesschate, S., van Dalen, A., van den Bos, D.D., Kuiper, S.Z., Pruijssers, S.R., Elliott, B.M., Geneta, V.P., Peng, S.L., Lim, Y.K., Yassaie, S.S., Correia, J.G., Vieira, B.N., Quintela, A.C., Serra, M.L., Aparício, D.J., Eiró, F., Almeida, M.R., Machado, N.D., Ćuk, V.V., Mészárosová, K., García Cardo, J., Mora-Guzmán, I., Jimenez Viñas, C., Gómez Del Pulgar, A., Fairén Oro, C., López Otero, M., Figueroa Jiménez, S., Martínez Caballero, J., Rubio-Pérez, I., Aguilar-Martínez, M.M., Segura-Sampedro, J.J., Estévez Diz, A.M., Martín-Balbuena, R., Licardie Bolaños, R.E., Fernández, P., Díaz Padillo, A., Alberdi San Román, I., Salvador Rosés, H., Merayo Álvarez, M., Lopes Moreira, C.C., Ripollés-Melchor, J., Gómez Facundo, H., V Pérez Guarinos, C., Yurdaor, S.S., Ozmen, B.B., Kocer, M.D., Cinar, E.N., Uslu, Ö., Farhan-Alanie, M., Finch, B.J., Liu, F.Y., Nadama, H.H., Tam, J., Gan, F.W., Hey, C.Y., Findlay, J.M., Örhalmi, J., Skalický, P., Skalický, T., Worsøe, J., Kristensen, E.S., Emmertsen, K.J., Loeve, U.S., Mihaljevic, A.L., Konstantinidis, K.M., Bisagni, P., Altomare, D.F., Sivinš, A., Bemelman, W.A., Graat, L.J., Wijnhoven, B., van de Ven, A., Stassen, L., Acherman, Y., Gerhards, M.F., Stommel, M., Hazebroek, E.J., van Geloven, A., Schasfoort, R.A., van Leeuwen, B.L., Tuynman, J.B., van Tilburg, M., Boerma, E.G., Bissett, I.P., Ourô, S., Caratão, M., Ridgway, P.F., McNamara, D.A., O'Connell, P.R., Ćuk, V.M., García, J., Espí Macías, A., Luján Mompeán, J.A., Romero Simó, M., Sánchez-Guillén, L., Jiménez-Gómez, L.M., Sánchez López, A., Julià Bergkvist, D., Noguera Aguilar, J.F., Rodríguez Sánchez, A., Cañete-Gómez, J., Millán-Scheiding, M., García Olmo, D., Hübner, M., Sauvain, M.O., Geçim, I.E., Disçi, E., Haksal, M.C., Erturk, M.S., Ozbalci, G.S., McIntyre, R., Moug, S.J., Lund, J.N., Smart, N.J., Knowles, C.H., Hany, T.S., Smith, F.M., Borg, C.M., Lee, Y.J., Lai, L.T., Jun, H., Mendis, D.M., Robb, P.M., Lee, H.J., Wyche, A., Davis, L.T., Jayalath, J., Blefari, N., Goh, Y.K., Beh, Y.Z., Dudi-Venkata, N.N., Borrow, J.L., Chua, T.H., Tan, R.R., Teh, J.S., Ng, S.Y., Pham, H., Coulter-Nile, S., Gosselink, M.P., Wang, Y.L., Chrapko, P.S., Pös, M., Bartoš, M., Malý, O., Hanušová, M., Hurný, M., Riško, J., Treskoň, R., Pospíšil, M., Hlaváčová, L., Tomanová, D., Novický, R., Sobotková, K., Šuta Kimle, K., Paclík, A., Jürgens-Lahnstein, J., Kristensen, F.P., Bønnerup, K., Højgaard Pedersen, J., Jepsen, B.N., Hillgaard, T.K., Erichsen, S.B., Nielsen, C.V., Madsen, C.P., Skejø, C.D., Aabling, R.R., Sørensen, J.S., Schöning, L., Cs Simon, S., Thäwel, T., Seckler, A.M., Athanasopoulos, P.G., Giuffrida, M.C., Billo, M.E., Marrosu, A.G., Ruggiu, M.W., Antona, A.D., Bitonti, M.F., Romano, F.M., Pellicanò, G.A., Murru, M.L., Angelucci, G.P., Tenconi, S.M., Mura, F.A., Ruggiu, G.V., Mura, G.A., Perrone, B.A., Esposito, L.M., Marcianò, M., Milani, M.S., Aru, A.C., Figà, F., Truškovs, A., Machatschek, M.J., Wiemann, A.M., Müller, N.L., Samalavicius, N.E., Poškus, E., Kryžauskas, M., Poškus, T., Looijen, R.C., Becker, M., Te Molder, L., Tissen, Y.M., de Vries, H.S., van Smaalen, T.C., Veen, O.C., Dingemans, S.A., van den Brink, L.C., Vijgen, G., van de Voort, E., van Rest, K., Sluijpers, N., Molenaar, C., Gordinou de Gouberville, M.C., Mens, M.A., Hoeks, E.M., van Praag, E.M., Smit, M., van der Lely, S.J., Stijns, R., Leow, T., Aarts, C., Tulek, M.S., Alqethami, H.J., van Elst, P.C., Tissink, M.W., Grüter, A., Voeten, D.M., Boon, C.L., Franssen, R., Jense, M., Lau, W.K., Adams, S., Chen, S.Y., Kim, D.H., McLaughlin, S., Chapman, D.A., McIntosh, N.D., Yam, S.T., Tomé, M., Santos, T.C., Lages, R.R., Sá, T.C., Bernardes, F.M., Cunha, M.F., Veiga, D.N., Loureiro, A.R., Torre, A.P., Paixão, I., Rocha, A.F., Jervis, M.J., Paixão, V., Silva, A.G., Galvão, D., Mónica, I., Guimarães, N., Martins, S.F., Patrício, J., Cinza, A.M., Simões, J., Gonçalves, J.P., Guimarães, J., Martins, A.R., Ferreira, A.S., Lérias, R., Bártolo, J., Correia, A.M., Martins, P.C., Jardim, J., Domingos, S.P., Baião, J.M., Rocha, B.S., Lopes, N., Jordão, D.M., Ângelo, M.D., Caroço, T., Gomes, J.R., Monteiro, R.G., McCaughey, C., Colon, L.F., Dockry, É., Aly, A.K., McPhedran, R., Kang, S.J., Pentony, A.R., Piong, C.L., Eow, S.Y., Kamath, P.J., Soh, T., Dyer, A.H., Chee, S.Y., Tan, I., McCawley, N., Jones, M.R., Popescu, S.S., Ciubotaru, C.I., Radulović, R., Miloševic, K., Bojičić, J., Genčić, M., Janković, U., Sucháň, P.K., Dubovský, M., Sautter, S.C., McDuling, C.R., Mana, O.C., Vicente Rodríguez, I., Jiménez Escovar, F., Calvo Fernández, M., Portugal Martínez, A., Del Pozo Andrés, E., Samartín Toimil, C., Primo Álvarez, J.C., Ossola, M.E., Martínez Illán, M., Aranda García, L., Lázaro Cardona, M., Livianos Arias-Camisón, P., Nieto Arranz, J.M., Mateos Sexmero, M.J., Liquete Marín, L., Pérez Calle, M., Ramos Cordero, M.J., Sánchez, E., Martínez Díaz, J.M., Ruiz Manzanera, J.J., Navarro Barrios, Á., Rodríguez Pedreño, L., García Moreno, P., García Gómez, M., Rifà Terricabras, S., Alberch Camprubí, E., Rico Ferrández, M., De Pablo Miró, M., Cañete-Manzanares, J., García Hernández, L.C., Orozco Nuñez, S., Soriano Liébana, M.M., Campo Betancourth, C.F., Bosch Ramírez, M., Ramayo Díaz, N., González Caraballo, I., Orue-Echebarria, M.I., Sánchez-Calvo, L., Morales Bernaldo de Quirós, J.T., Núñez O Sullivan, S., Ramos Jiménez, F.A., Pérez Ortega, A., Fernandez Illera, M.V., Sierra, J.E., Pinillos, A.I., Cornellà Garceso, N., García Ádamez, J., Sánchez, M.J., Martín-Borregón, P., Martínez, J., Marín, J.M., Rodríguez, P., Garcia Orozco, J.J., Ferrusola Diaz, D.A., Garcia Jimenez, M.L., Cifrián Canales, I., Calzada, M.G., Recuenco, C.B., Martin, M.C., Esteban Avendaño, I., Jiménez Relimpio, C., Blanco Bartolomé, I., Gómez Cano, I., Blasco Andrés, C., García-Vico, A., Sánchez-Gálvez, M.Á., Bersabe-Alonso, I.M., Gutierrez Rios, R.D., Ibañez Alda, M., Marínez-Hurtado, E., Salvachua-Fernández, R., Padilla Zegarra, E.D., Jerí-McFarlane, S., Pineño-Flores, C., Fernández-Vega, L., Gil-Catalán, A., Gómez Jurado, M.J., Belzunce-Capó, J.F., Navío, A., Abelló, D., Garcia, J.M., Giordano, H.E., Haller, M.L., Piotet, L.M., Kurtoglu, G.K., Sel, E.K., Isler, V.C., Yilmaz, B.S., Demirkaya, H.C., Korkmaz, H.K., Pektas, A.M., Güner, B., İşlek, E.C., Tombul, H.B., Boztuğ, C.Y., Tınaz, A., Yılmaz, M., Akın, F.A., Başçavuş, M., Seker, M.C., Koçak, Z.B., Karapinar, Y.E., Köseoglu, E., Agca, M.H., Alim, Y.E., Kürklü, Ö., Çalar, S.N., Kavar, R.C., Cevlik, A.D., Turk, E.G., Erdönmez, H., Gürsoy, F., Önsal, U., Özbek, M., Kasar, P.A., Özen, D., Ölmez, M., Sariçiçek, T., Tipi, O.U., Benli, G.E., Bilgili, A.C., Kiraz, I.N., Demirci, Z.S., Aksoy, A.B., Karagöz, E., Tümer, S.S., Abdulrahman, S., Kuyumcu, O.F., Afsar, H.B., Guler, S.E., Gul, E.B., Dossa, S., Mizan, S.R., Mazlum, S.S., Sahin, A.Z., Kilinç, A., Yumurtaci, Ö., Girit, Ç., Yildirak, M.K., Güldag, A., Söyleyici, B., Aytin, Y.E., Akay, F.E., Iskan, N.G., Sunay, A.O., McGuckin, S., Delaugere, L.P., Yeo, Y.Q., Aly, M.H., Bin Amran, M.A., Kyaw, H.A., Clements, J.M., Wong, H.L., McCusker, C., Armitage, M.N., Hussain, A.S., Hassan Serry, M.Y., Tam, L., Sookramanien, S.R., Ward, K.L., Pherwani, S.A., Drury, D.J., James, S.J., Teasdale, A.B., Richardson, E., Thomas, D.A., Williams, R.L., Najabat-Lattif, H.F., Zhu, L.Y., Mihailidis, T.H., Pedersen, A.C., Robinson, A.V., Cheong, C.M., Ike, S.I., Chu, T., Mogg, J., Claireaux, H.A., Al-Ausi, M., Shah, S.M., Alame, Y.J., Owen, W.J., Ahsan, S.D., Adam, A.H., Parekh, J.N., Martin-Hernandez, M.P., Soh, Y.J., Rassool, S.B., McMillan, M., Ling, J.J., Howard, E.O., Wadsworth, O.J., Meney, L.C., Kang, C.K., Chiu, J., McGee, F., Tan, Q.J., Cross, G., McTighe, A., Shah, D.R., Ng, M., Wong, R., Rojoa, D.M., Ruddy, C.M., Hall, J.D., Hassane, A., Azhar, A.W., Tan, T.K., Kwak, S.Y., Ong, E.H., McGregor, O., Lim, Q.X., Yong, S.Q., Chen, J.Y., Sam, Z.H., Goh, Y.N., Muthukumar, M.G., Johnson, T.A., Williams, R.I., McTiernan, M., McLaughlin, N., Honeyman, S.I., Malcolm, F.L., Wilkerson, H.T., Ahmed, W., Kwan, K., Boh, Z.Y., English, W.J., Novotny, S.A., Chong, J.T., Lee, D.E., McMurrugh, K., Clavé Llavall, A., Pang, Y.L., McClarty, C., Ngu, W.S., McIntosh, J., Alawode, D., Jones, C.S., Leung, S.P., Mohamed, S.H., Kok, J.Y., Lim, D., Fairfield, C.J., George, R.J., Hollywood, J.L., Hammond, R., Flint, E.J., Lee, Y.D., Skalický, A., Ojakäär, A., Dörr-Harim, C., Cufari, M.E., Gusai, G.P., Di Mola Ospedale Ss Annunziata, F.F., Loche, G.A., Stellingwerf, M.E., van de Pas, K., Brandsma, A.M., Rottier, S.J., Ong, H.I., O'Connor, D.B., Jovanović, M., Bernado, I.R., Paniagua Garcia Señorans, M., González Amor, L., Cuenca Ramírez, A., Cerdán, C., Gómez Romeu, N., Enriquez-Navascues, J.M., Uygur, F.A., Eray, I.C., Çetin, M.F., Isik, A.E., Sarıgül, L., Francis, A.A., Al-Hadithi, A., Lau, I., McAuliffe, O., Roche, C.D., Chaudhry, F.A., Amsterdam Gastroenterology Endocrinology Metabolism, Other Research, Graduate School, Surgery, Oncology, AII - Infectious diseases, and ACS - Microcirculation
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medicine.medical_specialty ,endocrine system ,general surgery ,Gastrointestinal ,endocrine system diseases ,Settore MED/18 - CHIRURGIA GENERALE ,pulmonary complications ,03 medical and health sciences ,0302 clinical medicine ,Ileus ,Nasogastric tube insertion ,Medicine ,pulmonary complication ,pneumonia ,EPIDEMIOLOGY ,Humans ,Prospective Studies ,colorectal surgery ,nasogastric tube ,Prospective cohort study ,Intubation, Gastrointestinal ,OUTCOMES ,VENTILATOR-ASSOCIATED PNEUMONIA ,business.industry ,Elective Surgical Procedures ,Pneumonia ,Confounding ,Gastroenterology ,nutritional and metabolic diseases ,Odds ratio ,Postoperative pneumonia ,medicine.disease ,Colorectal surgery ,Surgery ,body regions ,Intubation, Gastrointestinal/adverse effects ,Pneumonia/epidemiology ,Pneumonia/etiology ,Pneumonia/prevention & control ,030220 oncology & carcinogenesis ,Vomiting ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Intubation ,hormones, hormone substitutes, and hormone antagonists - Abstract
© 2020 The Association of Coloproctology of Great Britain and IrelandAim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion.
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- 2020
179. Development and Performance Assessment of Novel Machine Learning Models to Predict Postoperative Pneumonia After Liver Transplantation
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Dong Yang, Yihan Zhang, Yang Yang, Ziqing Hei, Shilong Gao, Liubing Chen, Shaoli Zhou, Zihan Mo, Bohan Wang, and Chaojin Chen
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Receiver operating characteristic ,Orthotopic liver transplantation ,business.industry ,medicine.medical_treatment ,Postoperative pneumonia ,Liver transplantation ,Machine learning ,computer.software_genre ,Logistic regression ,medicine.disease ,Pneumonia ,Informed consent ,medicine ,Artificial intelligence ,Extreme gradient boosting ,business ,computer - Abstract
Background/Aims: Postoperative pneumonia commonly occurs in patients after orthotopic liver transplantation ( OLT ), contributing to both morbidity and mortality. Until now, it remains a change in predicting postoperative pneumonia among patients following OLT. In this study, we aimed to develop machine learning (ML) models and to assess their performance for predicting postoperative pneumonia in OLT patients. Methods: Preoperative, intraoperative, and postoperative data of 591 adult patients who underwent OLT from January 2015 to September 2019 were retrospectively analyzed in this study. Six ML models, including logistic regression (LR), support vector machine ( SVM ), random forest ( RF ), multilayer perceptron ( MLP ), extreme gradient boosting ( XGBoost ), and gradient boosting machine ( GBM ) were developed using the training set and assessed using the testing set for their performance in predicting operative pneumonia. Findings: Postoperative pneumonia occurred in 42.81% of OLT patients, which contributed significantly to increased postoperative hospital stay and mortality. 14 features, including INR, HCT, PLT, ALB, ALT, FIB, WBC, PT, serum Na+, TBIL, anesthesia time, preoperative length of hospital stay, total fluid transfusion, and operation time, were significantly associated with postoperative pneumonia. Performance comparison of the six ML models revealed that the XGBoost model exhibited the best overall performance in predicting postoperative pneumonia, with the area under the receiver operating characteristics (ROC) curve (AUC) of 0.734, sensitivity of 52.6%, and specificity of 77.5%. Conclusions: This study has successfully established six novel ML models, of which the XGBoost model has demonstrated best over performance for predicting postoperative pneumonia in OLT patients, and thus it holds promise for clinical application in the future. Trial Registration : No.[2019]02-609-01 Funding Statement: This study was supported by the National Natural Science Foundation of China (Grant No. 81772127; 81974296), Postdoctoral Science Foundation of China (Grant No. 2019M663260) and the Fundamental Research Funds for the Central Universities, China (Grant No. 20ykpy20). Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: This study was approved by the Ethnic Committee of in the Third Affiliated Hospital of Sun Yat-sen University-Lingnan Hospital (No. [2019]02-609-01). The requirement for informed consent was waived by the committee, mainly due to the retrospective nature of this study
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- 2020
180. The masseter muscle thickness is a predictive marker for postoperative pneumonia after endovascular aneurysm repair.
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Ito E, Ohki T, Nakagawa H, and Toya N
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- Female, Humans, Male, Masseter Muscle diagnostic imaging, Masseter Muscle surgery, Retrospective Studies, Treatment Outcome, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation, Endovascular Procedures adverse effects, Pneumonia epidemiology, Pneumonia etiology
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Purpose: Oral frailty is characterized by a decrease in the oral and swallowing function and is a risk factor for pneumonia. In the current study, we analyzed the association between the masseter muscle thickness (MMT) and postoperative pneumonia and mortality after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm., Methods: Overall, 247 patients were retrospectively evaluated. The primary end point was postoperative pneumonia. The MMT was measured as the maximum thickness of the masseter muscle 2 cm caudal to the zygomatic arch using computed tomography images obtained within 3 months before EVAR. Pneumonia was defined as the presence of progressive infiltrates, consolidation, or cavitation on imaging and a fever or leukocytosis., Results: Twenty (8.1%) cases of postoperative pneumonia occurred within 1 year after EVAR. We found that patients with a low MMT (≤ 30th percentile: males, 10.4 mm; females: 8.8 mm) had a significantly higher risk of developing postoperative pneumonia within 1 year after elective EVAR than those with a high value. A comparison of the utility of the MMT and psoas muscle index (PMI) for predicting the 1-, 3-, and 5-year all-cause mortality revealed that the MMT had superior predictive performance., Conclusion: The MMT before elective EVAR predicted postoperative pneumonia and life expectancy, and its predictive performance was superior to that of the PMI., (© 2022. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)
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- 2022
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181. Partial COVID-19 vaccination associated with reduction in postoperative mortality and SARS-CoV-2 infection.
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Prasad NK, Englum BR, Mayorga-Carlin M, Turner DJ, Sahoo S, Sorkin JD, and Lal BK
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- COVID-19 Vaccines, Humans, Postoperative Complications epidemiology, Postoperative Complications prevention & control, SARS-CoV-2, Vaccination, COVID-19 epidemiology, COVID-19 prevention & control, Pneumonia
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Background: There are currently no data to guide decisions about delaying surgery to achieve full vaccination., Methods: We analyzed data from patients undergoing surgery at any of the 1,283 VA medical facilities nationwide and compared postoperative complication rates by vaccination status., Results: Of 87,073 surgical patients, 20% were fully vaccinated, 15% partially vaccinated, and 65% unvaccinated. Mortality was reduced in full vaccination vs. unvaccinated (Incidence Rate Ratio 0.77, 95% CI [0.62, 0.94]) and partially vaccinated vs. unvaccinated (0.75 [0.60, 0.94]). Postoperative COVID-19 infection was reduced in fully (0.18 [0.12, 0.26]) and partially vaccinated patients (0.34 [0.24, 0.48]). Fully vaccinated compared to partially vaccinated patients, had similar postoperative mortality (1.02, [0.78, 1.33]), but had decreased COVID-19 infection (0.53 [0.32, 0.87]), pneumonia (0.75 [0.62, 0.93]), and pulmonary failure (0.79 [0.68, 0.93])., Conclusions: Full and partial vaccination reduces postoperative complications indicating the importance of any degree of vaccination prior to surgery., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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182. Effect of differences in extubation timing on postoperative pneumonia following meningioma resection: a retrospective cohort study.
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Guo M, Shi Y, Gao J, Yu M, and Liu C
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- Aged, Airway Extubation adverse effects, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors, Meningeal Neoplasms complications, Meningeal Neoplasms surgery, Meningioma complications, Meningioma surgery, Pneumonia epidemiology, Pneumonia etiology
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Background: This study was designed to examine extubation time and to determine its association with postoperative pneumonia (POP) after meningioma resection., Methods: We studied extubation time for 598 patients undergoing meningioma resection from January 2016 to December 2020. Extubation time was analysed as a categorical variable and patients were grouped into extubation within 21 minutes, 21-35 minutes and ≥ 35 minutes. Our primary outcome represented the incidence of POP. The association between extubation time and POP was assessed using multivariable logistic regression mixed-effects models which adjusted for confounders previously reported. Propensity score matching (PSM) was also performed at a ratio of 1:1 to minimize potential bias., Results: Among 598 patients (mean age 56.1 ± 10.7 years, 75.8% female), the mean extubation time was 32.4 minutes. Extubation was performed within 21 minutes (32.4%), 21-35 minutes (31.2%) and ≥ 35 minutes (36.4%), respectively, after surgery. Older patients (mean age 57.8 years) were prone to delayed extubation (≥ 35 min) in the operating room, and more inclined to perioperative fluid infusion. When extubation time was analysed as a continuous variable, there was a U-shaped relation of extubation time with POP (P for nonlinearity = 0.044). After adjustment for confounders, extubation ≥35 minutes was associated with POP (odds ratio [OR], 2.73 95% confidence interval [CI], 1.36 ~ 5.47). Additionally, the results after PSM were consistent with those before matching., Conclusions: Delayed extubation after meningioma resection is associated with increased pneumonia incidence. Therefore, extubation should be performed as early as safely possible in the operation room., (© 2022. The Author(s).)
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- 2022
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183. High platelet distribution width is an independent risk factor of postoperative pneumonia in patients with type A acute aortic dissection.
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Xie X, Yan D, Liu X, Wang Y, Deng Y, Yao R, and Li N
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Background: Platelet distribution width (PDW), as a widely applied and reliable marker of platelet activation, was associated with adverse outcomes in cardiovascular diseases. However, there is little literature on the relationship between PDW and postoperative pneumonia in patients with type A acute aortic dissection (AAAD)., Methods: In this retrospective cohort study, we collected consecutive patients who underwent emergency surgery for AAAD at Xiangya Hospital of Central South University from January 1, 2014 and June 30, 2020. Patients were divided into three tertiles on the basis of the PDW. The independent effect of the PDW on postoperative pneumonia was evaluated using multivariate logistic regression analysis, and smooth curve fitting was performed to visualize the linear relationship between PDW and the risk of postoperative pneumonia in patients with AAAD., Results: A total of 210 patients with AAAD were enrolled and the overall incidence of postoperative pneumonia was 25.24% ( n = 53). Multivariate logistic regression revealed that PDW was positively associated with the risk of postoperative pneumonia (OR: 1.07, 95% CI: 1.02-1.13, P < 0.05) after adjusting the confounders. Compared with the lowest PDW tertile, the risk of postoperative pneumonia increased by 1.21-fold in the medium PDW tertile (OR: 2.21, 95% CI: 0.73-6.72) and by 3.16-fold in the highest PDW tertile (OR: 4.16, 95% CI: 1.40-12.33). A straight-line relationship was observed between PDW and postoperative pneumonia risk in smoothing spline fitting., Conclusion: Our findings indicate that high PDW is an independent risk factor of postoperative pneumonia in patients with AAAD. Preoperative PDW may serve as an available indicator of pneumonia, which helps identify AAAD patients with a high risk of postoperative pneumonia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Xie, Yan, Liu, Wang, Deng, Yao and Li.)
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- 2022
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184. The Role of an Array of Routine Clinical Variables to the Occurrence and Severity of Postoperative Pneumonia in Non–Small Cell Lung Cancer Patients
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Xiaoqu Li, Yanli Ji, Yutian Lai, Qingwei Shen, and Kun Zhou
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medicine.medical_specialty ,Clinical variables ,business.industry ,Postoperative pneumonia ,medicine.disease ,03 medical and health sciences ,Pneumonia ,0302 clinical medicine ,030228 respiratory system ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,Surgery ,Non small cell ,business ,Lung cancer - Abstract
Background and purpose: Data of an array of preoperative/intraoperative clinical variables may carry significant information for predicting the probability of postoperative pneumonia or chest infection in non–small cell lung cancer (NSCLC) patients. We aimed to investigate the association between those variables and the occurrence of postoperative pneumonia (POP) as well as the severity of POP, based on routine laboratory tests, basic characteristics, and perioperative variables during the in-hospital period. Methods: A consecutive series of NSCLC patients undergoing lung cancer lobectomy at our department from January 2014 and December 2015 was used as the target patient group and stratified into 2 groups: pneumonia (POP) and non-pneumonia (N-POP), according to occurrence of pneumonia after lobectomy in 30 days. The POP was classified into 5 severity grades, based on the Clavien-Dindo complication classification system. Results: Regarding binary logistic regression analysis for risk factors of POP, the following were found to be the independent risk factors of the occurrence of POP: postoperative predicted forced expiratory volume in 1 second [ppoFEV1%; odds ratio (OR): 0.996, 95% confidence interval (CI): 0.993–0.999; P = 0.021]; Charlson comorbidity index (CCI) score >3 (OR: 2.694, 95% CI: 1.462–4.965; P = 0.001); American Society of Anesthesiologists (ASA)score >3 (OR: 2.066, 95% CI: 1.060–4.029; P = 0.033); postoperative predicted diffusion capacity for carbon monoxide of the lung (ppoDlco%; OR: 0.458, 95% CI: 0.090–0.809; P = 0.014); and neutrophil-lymphocyte ratio (NLR; OR: 2.171, 95% CI: 1.721–2.737; P < 0.001). With regard to risk factors analysis of pneumonia severity via ordinal polytomous logistic regression, the following were the independent risk factors: early stage (OR: 0.626, 95% CI: 0.422–0.929, P = 0.020); CCI score >3 (OR: 1.914, 95% CI: 1.058–3.459, P = 0.032); ppoDlco% (OR: 0.638, 95% CI: 0.445–0.914, P = 0.014); and NLR (OR: 1.218, 95% CI: 1.031–1.436, P = 0.020). Conclusion: Among an array of clinical variables in the hospital, major risk factors for POP following LC surgery were ppoFEV1%, ppoDlco%, NLR, ASA score >3, and CCI score>3; meanwhile, ppoDlco%, CCI score>3, NLR, and early tumor stage were the key predictors of POP severity.
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- 2018
185. A Retrospective Study of the Efficacy of Perioperative Oral Management on Prevention of Postoperative Pneumonia Associated with Lung Cancer Surgery
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lung cancer ,risk factor ,周術期口腔機能管理 ,術後肺炎 ,perioperative oral management ,リスク因子 ,postoperative pneumonia ,肺癌 - Abstract
Article, 信州医学雑誌 66(4): 249-256(2018)
- Published
- 2018
186. Postoperative pneumonia among patients with and without COPD in Spain from 2001 to 2015
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José María de Miguel-Yanes, Isabel Jiménez-Trujillo, Manuel Méndez-Bailón, Valentín Hernández-Barrera, Ana López-de-Andrés, Rodrigo Jiménez-García, and Javier de Miguel-Díez
- Subjects
Adult ,Male ,medicine.medical_specialty ,Comorbidity ,Disease ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,Age Distribution ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Hospital Mortality ,030212 general & internal medicine ,Sex Distribution ,Medical diagnosis ,Aged ,Retrospective Studies ,Aged, 80 and over ,COPD ,business.industry ,Incidence ,Incidence (epidemiology) ,Hospital discharge database ,Pneumonia ,Middle Aged ,Surgical procedures ,Postoperative pneumonia ,medicine.disease ,Patient Discharge ,respiratory tract diseases ,Logistic Models ,030228 respiratory system ,Spain ,Female ,business - Abstract
To describe and compare incidence, characteristics and outcomes of postoperative pneumonia among patients with or without COPD.We included hospitalized patients aged ≥40 years whose medical diagnosis included pneumonia and ventilator-associated pneumonia in the secondary's diagnosis field and who were discharged from Spanish hospitals from 2001 to 2015. Irrespectively of the position at the procedures coding list, we retrieved data about the type of surgical procedures using the enhanced ICD-9-CM codes. We grouped admissions by COPD status. The data were collected from the National Hospital Discharge Database.We included 117,665 hospitalizations of patients that developed postoperative pneumonia (18.06% of them had COPD). The incidence of postoperative pneumonia was significantly higher in COPD patients than in those without COPD (IRR 1.93, 95%CI 1.68-2.24). In hospital-mortality (IHM) was significantly lower in the first group of patients (29.79% vs 31.43%, p 0.05). Factors independently associated with IHM, among COPD and non-COPD patients, were older age, more comorbidities, mechanical ventilation, pleural drainage tube, red blood cell transfusion, dialysis and emergency room admission. Time trend analysis showed a significant decrease in IHM from 2001 to 2015. COPD was associated with lower IHM (OR 0.91, 95%CI 0.88-0.95).The incidence of postoperative pneumonia was higher in COPD patients than in those without this disease. However, IHM was lower among COPD patients. IHM decreased over time, regardless of the existence or not of COPD.
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- 2018
187. Predictors of postoperative pneumonia in patients undergoing oral cancer resections and its management
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Deepak Balasubramanian, Jerry Paul, Sivakumar Vidhyadharan, Krishnakumar Thankappan, Subramania Iyer, Sobha Subramanian, Sunil Rajan, and Ridhi Sood
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medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Oral cancer ,lcsh:Surgery ,Intensivist ,Retrospective cohort study ,Chest physiotherapy ,lcsh:RD1-811 ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Intensive care unit ,lcsh:RC254-282 ,law.invention ,Surgery ,Nursing care ,Pneumonia ,law ,Medicine ,Klebsiella pneumonia ,business ,postoperative pneumonia ,preventive strategies - Abstract
Background: Head-and-neck resections carry a major risk of postoperative pulmonary complications. It adds to morbidity and mortality, adversely affects recovery, and contributes to financial burden. The objective of this study is to find out the incidence of pneumonia and the utility of our institution protocol in the prevention of postoperative pneumonia (POP). Materials and Methods: Retrospective study including patients undergoing oral cavity resection at the tertiary hospital from August 2017 to July 2018. The patients were analyzed in terms of demographic profile, operative findings, and postoperative course. Diagnosis of pneumonia was established by intensivist based on symptoms and signs. Results: Incidence of pneumonia was 5.79% (15 out of 239). Average age of patients with pneumonia was 64.8 years and 60% were male. All had multiple comorbidities. Average preoperative serum albumin was 3.49. POP was seen commonly in patients who had composite resections involving alveolar arch and tongue (26.67%). Majority had reconstruction in the form of free flap (46.6%) with fibula flap being most common. Average intraoperative time was 10.5 h. The most common isolate was Pseudomonas aeruginosa (40%), followed by Klebsiella pneumonia (33.3%). About 26% were multidrug-resistant strains. Average hospital stay was found to be 30.6 days in patients of pneumonia. Conclusions: Data from our cohort indicated a much lower incidence compared to published literature. We attribute this to our routine practice of intensive care unit care in the immediate postoperative setting with a nursing care ratio of 1:1, postoperative early mobilization, frequent tracheal toileting, chest physiotherapy, early diagnosis of pneumonia, and prompt initiation of treatment.
- Published
- 2018
188. POSTOPERATIVE PNEUMONIA: PREVENTION AND TREATMENT IN URGENT ABDOMINAL SURGERY
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Khayyam Shukhratovich Shaymardanov, Dzhamoliddin Abdulloevich Abdulloev, Muzaffar Kholnazarovich Nabiev, and Dzhamshed Emomalievich Madzhidov
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medicine.medical_specialty ,Environmental Engineering ,business.industry ,Medicine ,Postoperative pneumonia ,business ,Abdominal surgery ,Surgery - Abstract
Objective: Preventive maintenance and treatment of postoperative pneumonia in patients with urgent abdominal pathology. Methods: The results of examination and treatment of 86 patients with postoperative pneumonia (PP) for the period from 2005 to 2017 analyzed. There were 51 men (59.3%), women – 35 (40.7%). All patients were operated for the diffuse peritonitis caused by acute destructive appendicitis (n=21), perforated gastroduodenal ulcer (n=10), strangulated ventral hernia (n=4), acute intestinal obstruction (n=19), destructive forms of acute calculous cholecystitis (n=18) and acute destructive pancreatitis (n=14). In addition, the work presents the results of the application of the preventive measures developed by authors in 70 patients with urgent diseases of the abdominal cavity without PP. Results: To reduce the frequency of PP in patients with urgent surgical diseases of the abdominal cavity, complicated by intraperitoneal hypertension syndrome and enteral insufficiency, a method of antegrade intubation of the small intestine has been developed. In cases when after approaching of the edges of laparotomic wounds, the intra-abdominal pressure was above 15 mm Hg, the operation completed by hemming to the edges of the aponeurosis using a polypropylene mesh. The use of preventive endoprosthetics allowed to increase the volume of the abdominal cavity and, thereby, to level out the high standing of the diaphragm and the lung compressions, which was a surgical preventive maintenance of PP. After completion of the operation, in 22 cases, a catheterization of the small intestine mesentery was performed with subsequent introduction of 10 mg of serotonin adipate twice daily with a microdose jet pump SN-50. The patients observed the resolution of paresis on the second day after the surgery. Conclusion: Proposed measures for the prevention of PP allow to significantly improve the immediate results of surgical treatment of urgent diseases of the abdominal cavity by reducing the incidence of nonspecific complications. The use of serotonin adipate promotes the normalization of automatism and contractile activity of the smooth muscles of the intestine and allows reducing the frequency of complications and lethality among this complex category of patients. Keywords: Postoperative pneumonia, abdominal cavity, serotonin adipate.
- Published
- 2018
189. Incidence and risk factors of postoperative pneumonia following cancer surgery in adult patients with selected solid cancer: results of 'Cancer POP' study
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Jiwon Jung, Sung-Han Kim, Bo Jeong Seo, Cheol-In Kang, Song Mi Moon, Yong Kyun Cho, Seung-Ji Kang, Juneyoung Lee, Chang Sik Yu, Young Joo Kim, Seong Beom Park, Jae-Bum Jun, and Hee-Chang Jang
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Male ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,colorectal cancer ,03 medical and health sciences ,Breast cancer ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Neoplasms ,Internal medicine ,Republic of Korea ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cumulative incidence ,030212 general & internal medicine ,Lung cancer ,postoperative pneumonia ,Original Research ,Aged ,Retrospective Studies ,business.industry ,gastric cancer ,Incidence ,Incidence (epidemiology) ,Age Factors ,Cancer ,Retrospective cohort study ,hepatocellular carcinoma ,Pneumonia ,Middle Aged ,medicine.disease ,lung cancer ,Oncology ,Surgical Procedures, Operative ,030220 oncology & carcinogenesis ,Female ,business ,Cancer Prevention - Abstract
The aim of this study was to investigate the incidence and risk factors of postoperative pneumonia (POP) within 1 year after cancer surgery in patients with the five most common cancers (gastric, colorectal, lung, breast cancer, and hepatocellular carcinoma [HCC]) in South Korea. This was a multicenter and retrospective cohort study performed at five nationwide cancer centers. The number of cancer patients in each center was allocated by the proportion of cancer surgery. Adult patients were randomly selected according to the allocated number, among those who underwent cancer surgery from January to December 2014 within 6 months after diagnosis of cancer. One‐year cumulative incidence of POP was estimated using Kaplan–Meier analysis. An univariable Cox's proportional hazard regression analysis was performed to identify risk factors for POP development. As a multivariable analysis, confounders were adjusted using multiple Cox's PH regression model. Among the total 2000 patients, the numbers of patients with gastric cancer, colorectal cancer, lung cancer, breast cancer, and HCC were 497 (25%), 525 (26%), 277 (14%), 552 (28%), and 149 (7%), respectively. Overall, the 1‐year cumulative incidence of POP was 2.0% (95% CI, 1.4–2.6). The 1‐year cumulative incidences in each cancer were as follows: lung 8.0%, gastric 1.8%, colorectal 1.0%, HCC 0.7%, and breast 0.4%. In multivariable analysis, older age, higher Charlson comorbidity index (CCI) score, ulcer disease, history of pneumonia, and smoking were related with POP development. In conclusions, the 1‐year cumulative incidence of POP in the five most common cancers was 2%. Older age, higher CCI scores, smoker, ulcer disease, and previous pneumonia history increased the risk of POP development in cancer patients.
- Published
- 2017
190. Response to Comment on 'The Complexity of Defining Postoperative Pneumonia Following Esophageal Cancer Surgery
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John V. Reynolds, Narayanasamy Ravi, Brian O'Connell, Sinead King, Conor F. Murphy, Nicola Raftery, and Claire L. Donohoe
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medicine.medical_specialty ,Text mining ,business.industry ,medicine ,MEDLINE ,Surgery ,Esophageal cancer ,Postoperative pneumonia ,Lung injury ,Infective complication ,medicine.disease ,business - Published
- 2021
191. Comments on 'The Complexity of Defining Postoperative Pneumonia Following Esophageal Cancer Surgery: A Spectrum of Lung Injury Rather Than a Simple Infective Complication?'
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Yoshifumi Baba, Keisuke Kosumi, and Hideo Baba
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medicine.medical_specialty ,Esophageal Neoplasms ,business.industry ,MEDLINE ,Lung Injury ,Pneumonia ,Postoperative pneumonia ,Lung injury ,Esophageal cancer ,medicine.disease ,Perioperative Care ,Surgery ,Text mining ,Humans ,Medicine ,Infective complication ,business - Published
- 2021
192. Risk Factors for Postoperative Pneumonia: A Case-Control Study.
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Xiang B, Jiao S, Si Y, Yao Y, Yuan F, and Chen R
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- Adult, Case-Control Studies, Hospital Mortality, Humans, Length of Stay, Risk Factors, Pneumonia epidemiology, Pneumonia etiology
- Abstract
Background: Postoperative pneumonia is a preventable complication associated with adverse outcomes, that greatly aggravates the medical expenses of patients. The goal of our study is to identify risk factors and outcomes of postoperative pneumonia., Methods: A matched 1:1 case-control study, including adult patients who underwent surgery between January 2020 and June 2020, was conducted in the Second Affiliated Hospital of Kunming Medical University in China. Cases included all patients developing postoperative pneumonia within 30 days after surgery, defined using consensus criteria. Controls were selected randomly from the matched eligible population., Results: Out of 17,190 surgical patients, 264 (1.54%) experienced postoperative pneumonia. Increased age, chronic obstructive pulmonary disease, emergency surgery, postoperative reduced albumin, prolonged ventilation, and longer duration of bed rest were identified as significant risk factors independently associated with postoperative pneumonia. Regarding prognostic implications, postoperative pneumonia was associated with longer length of hospital stay, higher ICU occupancy rate, higher unplanned re-operation rate, and higher in-hospital mortality rate. Postoperative pneumonia was most commonly caused by Gram-negative pathogens, and multidrug resistant bacteria accounted for approximately 16.99% of cases., Conclusions: Postoperative pneumonia is associated with severe clinical outcomes. We identified six independent risk factors that can aid in risk stratification and management of patients at risk of postoperative pneumonia, and the distribution of causative pathogens can also help in the implementation of effective interventions., Clinical Trial Registration: www.chictr.org.cn, identifier: chiCTR2100045986., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Xiang, Jiao, Si, Yao, Yuan and Chen.)
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- 2022
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193. Association of Severe Obesity and Chronic Obstructive Pulmonary Disease With Pneumonia Following Non-Cardiac Surgery.
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Owusu-Bediako K, Pfaff K, Tram NK, Stahl DL, Tobias JD, Nafiu OO, and Mpody C
- Abstract
Background: Pneumonia is the third most common surgical complication after urinary tract infection and wound infections. In addition to increased mortality, patients who develop postoperative pneumonia have a higher risk of prolonged hospital stay, intensive care unit (ICU) admissions, and higher healthcare costs. Obesity and chronic obstructive pulmonary disease (COPD) are both independent risk factors for the development and severity of postoperative pneumonia, although the combined effect of these comorbidities is unknown. Therefore, we evaluated whether the combination of severe obesity and COPD is associated with an increased risk of postoperative pneumonia., Methods: We performed a multicenter retrospective cohort study of 365,273 patients aged 18 - 64 years who were either severely obese (body mass index (BMI) ≥ 40 kg/m
2 ) or normal-weight (BMI between 18.6 and 24.9 kg/m2 ) and underwent general surgery, orthopedic surgery, neurosurgery, otolaryngology surgery, urology surgery, and vascular surgery in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) participating hospitals from 2014 to 2018. We evaluated the combined effect of COPD and severe obesity on the risk for postoperative pneumonia, unplanned tracheal reintubation, and extended length of stay., Results: The co-occurrence of severe obesity and COPD appeared to have a protective effect on the risk of postoperative pneumonia. In the presence of COPD, patients with severe obesity were 14% less likely to develop pneumonia compared to their normal-weight counterparts (2.9% vs. 4.4%; adjusted relative risk (RR): 0.76; 95% confidence interval (CI): 0.60, 0.95). In addition, in the presence of COPD, severe obesity conferred a lower risk for requiring an extended length of stay (37.6% vs. 47.9%; adjusted RR: 0.83; 95% CI: 0.78, 0.89)., Conclusions: Counterintuitively, the co-occurrence of severe obesity with COPD appeared to buffer the negative impact of COPD on postoperative pneumonia, unplanned tracheal reintubation, and prolonged hospital stay after noncardiac surgery. These findings are consistent with the obesity paradox and warrant further investigations., Competing Interests: The authors have no conflict of interest relevant to this article to disclose., (Copyright 2022, Owusu-Bediako et al.)- Published
- 2022
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194. Risk Stratification of Postoperative Pneumonia in Patients Undergoing Subtotal Esophagectomy for Esophageal Cancer.
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Takahashi K, Nishikawa K, Tanishima Y, Ishikawa Y, Kurogochi T, Yuda M, Tanaka Y, Matsumoto A, Yano F, and Eto K
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- Blood Loss, Surgical, Esophagectomy adverse effects, Esophagectomy methods, Humans, Postoperative Complications epidemiology, Retrospective Studies, Risk Assessment, Esophageal Neoplasms complications, Pneumonia epidemiology, Pneumonia etiology, Pneumonia surgery, Vocal Cord Paralysis etiology
- Abstract
Background/aim: Despite recent progress in surgical techniques and perioperative management, postesophagectomy pneumonia remains the most common complication. Thus, it is important to identify the risk factors of postoperative pneumonia and to improve perioperative management. This study aimed to clarify risk factors for postoperative pneumonia and subsequently stratify the risk of pneumonia., Patients and Methods: A total of 154 patients who underwent subtotal esophagectomy were divided into two groups: patients without pneumonia and those with pneumonia. Their backgrounds and operative outcomes were compared. Furthermore, risk factors of postoperative pneumonia were evaluated using a logistic regression model., Results: Postoperative pneumonia developed in 18.8% (n=29) of the study cohort. In the multivariate analysis, the independent risk factors for postoperative pneumonia were forced expiratory volume at 1 s (FEV1) <1.98 l [p=0.011; odds ratio (OR)=3.960; 95% confidence interval (CI)=1.380-11.400], thoracotomy (p=0.043; OR=3.110; 95%CI=1.030-9.320), operative blood loss ≥390 ml (p=0.013; OR=3.900; 95%CI=1.340-11.400), and recurrent laryngeal nerve palsy (RLNP) (p=0.014; OR=3.740; 95%CI=1.310-10.700). Patients were also stratified into the following four groups as per the number of significant risk factors: the incidence of pneumonia in patients with no risk factor, one risk factor, two risk factors, three risk factors were 7.0% (5/71), 13.7% (7/51), 43.5% (10/23), and 77.7% (7/9), respectively., Conclusion: FEV1 <1.98 l, thoracotomy, operative blood loss ≥390 ml, and RLNP were independent risk factors of postoperative pneumonia. Additionally, patients could be stratified into four groups according to the incidence of pneumonia., (Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)
- Published
- 2022
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195. Intraoperative nerve monitoring during esophagectomy reduces the risk of recurrent laryngeal nerve palsy.
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Yuda M, Nishikawa K, Ishikawa Y, Takahashi K, Kurogochi T, Tanaka Y, Matsumoto A, Tanishima Y, Mitsumori N, and Ikegami T
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- Esophagectomy adverse effects, Esophagectomy methods, Humans, Monitoring, Intraoperative methods, Recurrent Laryngeal Nerve pathology, Thyroidectomy adverse effects, Esophageal Neoplasms pathology, Pneumonia complications, Vocal Cord Paralysis epidemiology, Vocal Cord Paralysis etiology, Vocal Cord Paralysis prevention & control
- Abstract
Background: Despite the risk of recurrent laryngeal nerve (RLN) palsy during esophagectomy, no established method of monitoring RLN injury is currently available., Methods: This study included 187 patients who underwent esophagectomy between 2011 and 2018. Among these, intraoperative nerve monitoring (IONM) was done in 142 patients (IONM group), while the remaining 45 patients underwent conventional surgery without IONM (control group). We investigated the incidence of postoperative complications with regard to the use of IONM., Results: The overall incidence of postoperative RLN palsy was 28% (52/187). The IONM group showed a significantly lower incidence of postoperative RLN palsy as compared to that in the control group (p = 0.004). The overall incidence of postoperative pneumonia was 22% (41/187) in those with Clavien-Dindo (CD) classification beyond grade 2. There were no significant differences between the incidence of any grade of postoperative pneumonia and the use of IONM (p = 0.195 and 0.333; CD > 2 and > 3, respectively). Multivariate analysis demonstrated that tumors in the upper third [odds ratio (OR) 3.12; 95% confidence interval (CI) 1.04-9.29] and lack of IONM use (OR 2.51; 95% CI 1.17-5.38) were independent factors causing postoperative RLN palsy after esophagectomy., Conclusion: IONM helps to reduce the risk of postoperative RLN palsy after esophageal cancer surgery., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2022
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196. Excessive intravenous crystalloid infusion after video-assisted thoracoscopic surgery lobectomy is associated with postoperative pneumonia
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Yang, Rong, Du, Chengli, Xu, Jinming, Yao, Linpeng, Zhang, Siying, and Wu, Yihe
- Published
- 2019
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197. Plasma Transfusion Is Associated With Postoperative Infectious Complications Following Esophageal Resection Surgery: A Retrospective Cohort Study.
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Subramanian, Arun, Berbari, Elie F., Brown, Michael J., Allen, Mark S., Alsara, Anas, and Kor, Daryl J.
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BLOOD plasma ,BLOOD transfusion ,SURGICAL complications ,COMPLICATIONS of cardiac surgery ,COHORT analysis ,RED blood cell transfusion ,BLOOD products - Abstract
Objective: To examine the association between blood component transfusions and the incidence of major postoperative infections in patients undergoing esophageal resection surgery. Design: Retrospective cohort study. Setting: Single academic tertiary referral center. Participants: All patients who underwent esophagectomy from 2005 through 2009. Measurements and Main Results: The primary outcome was the incidence of major postoperative infection, defined as pneumonia, bloodstream infection, and/or a surgical site infection occurring within 30 days postoperatively. In total, 465 patients were evaluated. One hundred thirty-eight patients (29.7%) received a blood transfusion before the onset of a major postoperative infection or during a similar exposure interval in those with no such complications. Univariate analysis showed a significant association between any blood component transfusion and postoperative infection (transfused v nontransfused 31.9% v 13.2%; odds ratio = 3.1, 95% confidence interval = 1.9-5.0; p < 0.01). This association was lost on multivariate analysis. Subgroup analysis with multivariate adjustment identified a significant association between high plasma volume blood component transfusions and postoperative infection (odds ratio = 4.2, 95% confidence interval = 1.2-15.8; p = 0.03). With multivariate adjustment, red blood cell administration was no longer associated with major postoperative infectious complications. Conclusions: High plasma volume blood component transfusions were associated with the development of major postoperative infectious complications in patients undergoing esophageal resection surgery. In contrast, red blood cell transfusion was not associated with infectious complications. [Copyright &y& Elsevier]
- Published
- 2012
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198. Emergency versus elective living-donor liver transplantation: a comparison of a single center analysis.
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Takeda, Kazuhisa, Tanaka, Kuniya, Kumamoto, Takafumi, Nojiri, Kazunori, Mori, Ryutaro, Taniguchi, Koichi, Matsuyama, Ryusei, and Endo, Itaru
- Subjects
- *
LIVER transplantation , *MORTALITY , *HEPATIC encephalopathy , *LYMPHOCYTES , *PNEUMONIA - Abstract
Purpose: We studied the risk factors for postoperative mortality between patients who underwent emergency or elective living-donor liver transplantation (LDLT). Methods: Forty-seven patients underwent LDLT in our institute, 16 for emergencies and 31 as elective procedures. The emergency LDLT status was applied to cases in which the time period between referral to our institution and transplantation did not exceed 10 days, and in which liver failure was accompanied by the presence of any degree of hepatic encephalopathy. Results: With regard to preoperative factors, age ( P = 0.03), the model for end-stage liver disease score ( P = 0.001), preoperative tracheal intubation ( P = 0.001), ratio between arterial oxygen tension and fractional inspired oxygen (PaO/FiO ratio) ( P = 0.03), steroid therapy use ( P = 0.001), lymphocyte count ( P = 0.02), and cases requiring hemodiafiltration ( P = 0.001) differed significantly between the two groups. Postoperative pneumonia occurred more frequently in emergency LDLT patients than in elective LDLT patients ( P = 0.006). Invasive pulmonary aspergillosis (IPA) was the main cause of postoperative death in emergency LDLT patients, and, in a univariate analysis, a preoperative status of high serum (1 → 3)- β- d-glucan (>20 pg/ml, P = 0.001), advanced age (>52 years, P = 0.02), and a low PaO/FiO ratio (<320, P = 0.01) were identified as factors predictive of IPA. Conclusion: Careful perioperative management, including preoperative investigation of aspergillosis and empiric antibiotic therapy, should be considered for emergency LDLT patients who fulfill IPA risk factors. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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199. Non-invasive ventilation in postoperative patients: a systematic review.
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Chiumello, D., Chevallard, G., and Gregoretti, C.
- Subjects
- *
POSTOPERATIVE care , *VENTILATION-perfusion ratio , *PULMONARY edema , *OBSTRUCTIVE lung diseases , *THORACIC surgery , *SYSTEMATIC reviews , *PATIENTS - Abstract
Background: Postoperative pulmonary complications, generally defined as any pulmonary abnormality occurring in the postoperative period, are still a significant issue in clinical practice increasing hospital length of stay, morbidity and mortality. Non-invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure, is nowadays also used in perioperative settings. Objective: Investigate the application and results of preventive and therapeutic NIV in postsurgical patients. Design: A systematic review. Data sources: Medical literature databases were searched for articles about 'clinical trials,' 'randomized controlled trials' and 'meta-analyses.' The keywords 'cardiac surgery,' 'thoracic surgery,' 'lung surgery,' 'abdominal surgery,' 'solid organ transplantation,' 'thoraco-abdominal surgery' and 'bariatric surgery' were combined with any of these: 'non-invasive positive pressure ventilation,' 'continuous positive airway pressure,' 'bilevel ventilation,' 'postoperative complications,' 'postoperative care,' 'respiratory care,' 'acute respiratory failure,' 'acute lung injury' and 'acute respiratory distress syndrome.' Results: Twenty-nine articles ( N = 2,279 patients) met the inclusion criteria. Nine studies evaluated NIV in post-abdominal surgery, three in thoracic surgery, eight in cardiac surgery, three in thoraco-abdominal surgery, four in bariatric surgery and two in post solid organ transplantation used both for prophylactic and therapeutic purposes. NIV improved arterial blood gases in 15 of the 22 prophylactic and in 4 of the 7 therapeutic studies, respectively. NIV reduced the intubation rate in 11 of the 29 studies and improved outcome in only 1. Conclusions: Despite these limited data and the necessity of new randomized trials, NIV could be considered as a prophylactic and therapeutic tool to improve gas exchange in postoperative patients. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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200. Relationship between the pathogens of postoperative pneumonia after an esophagectomy for thoracic esophageal cancer and the aggregate length of preoperative hospital stay.
- Author
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Tsubosa, Yasuhiro, Sato, Hiroshi, Bando, Etsuro, Ota, Yojiro, Tanuma, Akira, and Ohmagari, Norio
- Abstract
Oral care, respiratory physiotherapy, and rehabilitation for swallowing disorders are thought to be useful preventative measures for postoperative pneumonia in major surgeries. Despite these measures, postoperative pneumonia after an esophagectomy remains frequent and severe. However, few reports have documented the pathogens associated with postoperative pneumonia following surgery for esophageal cancer. Oral care, respiratory physiotherapy, and rehabilitation for swallowing disorders were introduced into the clinical path for transthoracic esophagectomies for esophageal cancer, and we retrospectively analyzed 191 patients who underwent an esophagectomy between September 2002 and December 2008. In 80 of 191 patients, sputum was harvested using routine bronchoscopy on the first or second postoperative day, and the pathogens were evaluated. The data were analyzed retrospectively. By reviewing the hospital records of all patients involved, information was obtained on demographic characteristics, preoperative pulmonary status, postoperative course, and aggregate length of preoperative hospital stay. The incidence of postoperative pneumonia was investigated, and the correlation between the aggregate length of preoperative hospital stay and infection by pathogens was analyzed. Postoperative pneumonia was diagnosed in 21 of 191 patients (11.0%). Univariate analyses of the relationships between postoperative pneumonia and all potential risk factors, including the length of preoperative hospital stay, showed no significant difference. Thirteen of 80 cases who underwent routine bronchoscopy contracted postoperative pneumonia. In 7 of 80 cases in which sputum was harvested by bronchoscopy, Pseudomonas aeruginosa was detected. The aggregate length of preoperative hospital stay was 5 days or more in all 7 cases. The positive rate for Pseudomonas aeruginosa in the postoperative pneumonia cases was 23.1% (3 of 13). The rate of postoperative pneumonia was about 10% despite preventative efforts including oral care, respiratory rehabilitation, and rehabilitation for swallowing disorders. In cases of postoperative pneumonia after a thoracic esophagectomy for esophageal cancer among patients with preoperative hospital stays of 5 days or more, it may be advisable to select empiric therapy covering multidrug-resistant gram-negative pathogens, especially Pseudomonas aeruginosa. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
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