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Mohseni, Shahin
Publikasjoner (10 av 23) Visa alla publikasjoner
Khalili, H., Ahl, R., Paydar, S., Sjölin, G., Cao, Y., Fard, H. A., . . . Mohseni, S. (2020). Beta-Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial. World Journal of Surgery
Åpne denne publikasjonen i ny fane eller vindu >>Beta-Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial
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2020 (engelsk)Inngår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323Artikkel i tidsskrift (Fagfellevurdert) Epub ahead of print
Abstract [en]

Background: Observational studies have demonstrated improved outcomes in TBI patients receiving in-hospital beta-blockers. The aim of this study is to conduct a randomized controlled trial examining the effect of beta-blockers on outcomes in TBI patients.

Methods: Adult patients with severe TBI (intracranial AIS >= 3) were included in the study. Hemodynamically stable patients at 24 h after injury were randomized to receive either 20 mg propranolol orally every 12 h up to 10 days or until discharge (BB+) or no propranolol (BB-). Outcomes of interest were in-hospital mortality and Glasgow Outcome Scale-Extended (GOS-E) score on discharge and at 6-month follow-up. Subgroup analysis including only isolated severe TBI (intracranial AIS >= 3 with extracranial AIS <= 2) was carried out. Poisson regression models were used.

Results: Two hundred nineteen randomized patients of whom 45% received BB were analyzed. There were no significant demographic or clinical differences between BB+ and BB- cohorts. No significant difference in inhospital mortality (adj. IRR 0.6 [95% CI 0.3-1.4], p = 0.2) or long-term functional outcome was measured between the cohorts (p = 0.3). One hundred fifty-four patients suffered isolated severe TBI of whom 44% received BB. The BB? group had significantly lower mortality relative to the BB- group (18.6% vs. 4.4%, p = 0.012). On regression analysis, propranolol had a significant protective effect on in-hospital mortality (adj. IRR 0.32, p = 0.04) and functional outcome at 6-month follow-up (GOS-E >= 5 adj. IRR 1.2, p = 0.02).

Conclusion: Propranolol decreases in-hospital mortality and improves long-term functional outcome in isolated severe TBI. This randomized trial speaks in favor of routine administration of beta-blocker therapy as part of a standardized neurointensive care protocol.

Level of evidence: Level II; therapeutic.

Study type: Therapeutic study.

sted, utgiver, år, opplag, sider
Springer, 2020
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-79883 (URN)10.1007/s00268-020-05391-8 (DOI)000510269300001 ()32002583 (PubMedID)
Merknad

Funding Agency:

Research department of Shiraz University of Medical Sciences  1396-01-3814792

Tilgjengelig fra: 2020-02-14 Laget: 2020-02-14 Sist oppdatert: 2020-02-14bibliografisk kontrollert
Stenberg, E., Mohseni, S., Cao, Y. & Näslund, E. (2020). Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery. Obesity Surgery, 30(1), 139-145
Åpne denne publikasjonen i ny fane eller vindu >>Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery
2020 (engelsk)Inngår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 30, nr 1, s. 139-145Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery.

METHODS: Patients operated with primary laparoscopic gastric bypass surgery in Sweden between 2007 and 2017 were identified through the Scandinavian Obesity Surgery Registry. The dataset was linked to the Swedish National Patient Registry, the Swedish Prescribed Drug Registry, and Statistics Sweden. The main outcome was serious postoperative complication within 30 days of surgery; with postoperative complication, 90-day and 1-year mortality, and weight loss at 2 years after surgery as secondary endpoints. The Poisson regression model was used to evaluate primary and secondary categorical outcomes. A general mixed model was performed to evaluate 2-year weight loss.

RESULTS: In all, 50281 patients were included in the study. No difference was seen between patients on beta-blockade and the control group regarding postoperative complications (adjusted incidence rate ratio 1.04 (95%CI 0.93-1.15), p = 0.506), serious postoperative complication (adjusted IRR 1.06 95%CI 0.89-1.27), p = 0.515), 90-day mortality (adjusted IRR 0.71 (95%CI 0.24-2.10), p = 0.537), and 1-year mortality (adjusted IRR 1.26 (95%CI 0.67-2.36), p = 0.467). Weight loss 2 years after surgery was slightly greater in patients on beta-blockade (adjusted coefficient 0.53 (95%CI 0.19-0.87), p = 0.002).

CONCLUSIONS: Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.

sted, utgiver, år, opplag, sider
Springer Science+Business Media B.V., 2020
Emneord
Beta-blockade, Gastric bypass, Postoperative outcome
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-75571 (URN)10.1007/s11695-019-04108-8 (DOI)000512073200018 ()31346982 (PubMedID)2-s2.0-85069715589 (Scopus ID)
Forskningsfinansiär
Novo NordiskStockholm County Council
Merknad

Funding Agencies:

Region Auvergne-Rhone-Alpes Region Bourgogne-Franche-Comte Region Hauts-de-France Region Nouvelle-Aquitaine OLL-884791

SRP Diabetes 

Tilgjengelig fra: 2019-08-09 Laget: 2019-08-09 Sist oppdatert: 2020-03-17bibliografisk kontrollert
Ahl, R., Matthiessen, P., Fang, X., Cao, Y., Sjölin, G., Lindgren, R., . . . Mohseni, S. (2020). β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes. Annals of Surgery, 271(1), 140-146
Åpne denne publikasjonen i ny fane eller vindu >>β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes
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2020 (engelsk)Inngår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, nr 1, s. 140-146Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE: To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.

BACKGROUND: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking.

METHODS: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model.

RESULTS: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37-0.52, P < 0.001).

CONCLUSIONS: Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.

sted, utgiver, år, opplag, sider
Lippincott Williams & Wilkins, 2020
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-74248 (URN)10.1097/SLA.0000000000002970 (DOI)30048321 (PubMedID)2-s2.0-85077036188 (Scopus ID)
Tilgjengelig fra: 2019-05-13 Laget: 2019-05-13 Sist oppdatert: 2020-01-13bibliografisk kontrollert
Maghami, S., Cao, Y., Ahlstrand, R., Detlofsson, E., Matthiessen, P., Sarani, B. & Mohseni, S. (2019). Beta-blocker Therapy is Associated with Decreased 1-year Mortality After Emergency Laparotomy in Geriatric Patients. Scandinavian Journal of Surgery, Article ID 1457496919877582.
Åpne denne publikasjonen i ny fane eller vindu >>Beta-blocker Therapy is Associated with Decreased 1-year Mortality After Emergency Laparotomy in Geriatric Patients
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2019 (engelsk)Inngår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, artikkel-id 1457496919877582Artikkel i tidsskrift (Fagfellevurdert) Epub ahead of print
Abstract [en]

BACKGROUND AND AIMS: Emergency laparotomy is associated with a great risk of mortality in the elderly. The hyperadrenergic state induced by surgical trauma may play an important role in the pathophysiology of this increased risk. Studies have shown that beta-blocker exposure may be associated with decreased morbidity and mortality in the perioperative period. We aimed to study the effect of beta-blocker on mortality in geriatric patients undergoing emergency laparotomy.

MATERIAL AND METHODS: ). The Poisson regression analysis was used to evaluate the association.

RESULTS:  = 0.004). No significant differences in the incidence of post-operative complications between the two groups could be measured.

CONCLUSION: Beta-blocker therapy may be associated with reduced 1-year mortality following emergency laparotomy in geriatric patients.

sted, utgiver, år, opplag, sider
Sage Publications, 2019
Emneord
Beta-blockers, emergency laparotomy, geriatrics, mortality
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-76831 (URN)10.1177/1457496919877582 (DOI)31544597 (PubMedID)
Tilgjengelig fra: 2019-09-30 Laget: 2019-09-30 Sist oppdatert: 2019-09-30bibliografisk kontrollert
Ahl, R., Matthiessen, P., Fang, X., Cao, Y., Sjölin, G., Lindgren, R., . . . Mohseni, S. (2019). Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery. British Journal of Surgery, 106(4), 477-483
Åpne denne publikasjonen i ny fane eller vindu >>Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery
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2019 (engelsk)Inngår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, nr 4, s. 477-483Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Emergency colorectal cancer surgery is associated with significant mortality. Induced adrenergic hyperactivity is thought to be an important contributor. Downregulating the effects of circulating catecholamines may reduce the risk of adverse outcomes. This study assessed whether regular preoperative beta-blockade reduced mortality after emergency colonic cancer surgery.

METHODS: This cohort study used the prospectively collected Swedish Colorectal Cancer Registry to recruit all adult patients requiring emergency colonic cancer surgery between 2011 and 2016. Patients were subdivided into those receiving regular beta-blocker therapy before surgery and those who were not (control). Demographics and clinical outcomes were compared. Risk factors for 30-day mortality were evaluated using Poisson regression analysis.

RESULTS: A total of 3187 patients were included, of whom 685 (21·5 per cent) used regular beta-blocker therapy before surgery. The overall 30-day mortality rate was significantly reduced in the beta-blocker group compared with controls: 3·1 (95 per cent c.i. 1·9 to 4·7) versus 8·6 (7·6 to 9·8) per cent respectively (P < 0·001). Beta-blocker therapy was the only modifiable protective factor identified in multivariable analysis of 30-day all-cause mortality (incidence rate ratio 0·31, 95 per cent c.i. 0·20 to 0·47; P < 0·001) and was associated with a significant reduction in death of cardiovascular, respiratory, sepsis and multiple organ failure origin.

CONCLUSION: Preoperative beta-blocker therapy may be associated with a reduction in 30-day mortality following emergency colonic cancer surgery.

sted, utgiver, år, opplag, sider
John Wiley & Sons, 2019
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-69119 (URN)10.1002/bjs.10988 (DOI)000459801800023 ()30259967 (PubMedID)
Tilgjengelig fra: 2018-10-01 Laget: 2018-10-01 Sist oppdatert: 2019-05-13bibliografisk kontrollert
Ah, R., BChir, M. B., Cao, Y., Geijer, H., Taha, K., Pourhossein-Sarmeh, S., . . . Mohseni, S. (2019). Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients. Bulletin of emergency and trauma, 7(3), 223-231
Åpne denne publikasjonen i ny fane eller vindu >>Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients
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2019 (engelsk)Inngår i: Bulletin of emergency and trauma, ISSN 2322-2522, Vol. 7, nr 3, s. 223-231Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: To evaluate the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy.

Methods: All geriatric patients (≥65 years) undergoing emergency laparotomy at a single university hospital between 1/2015 and 12/2016 were included in this cohort study. Demographics and outcomes were retrospectively collected from medical records. Association between prognostic markers and 30-day mortality was assessed using Poisson and backward stepwise regression models. Prognostic value was assessed using receiver operating characteristic (ROC) curves.

Results: =0.004) while osteopenia was not. P-POSSUM had poor prognostic value for 30-day mortality with an area under the ROC curve (AUC) of 0.59. The prognostic value of P-POSSUM improved significantly when adjusting for patient covariates (AUC=0.83).

Conclusion: P-POSSUM and osteopenia alone hardly predict 30-day mortality in geriatric patients following emergency laparotomy. P-POSSUM adjusted for other patient covariates improves the prediction.

sted, utgiver, år, opplag, sider
Shiraz University of Medical Sciences, 2019
Emneord
Emergency Laparotomy, Emergency Surgery, Geriatric, Mortality
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-79242 (URN)10.29252/beat-070303 (DOI)31392220 (PubMedID)
Tilgjengelig fra: 2020-01-20 Laget: 2020-01-20 Sist oppdatert: 2020-01-22bibliografisk kontrollert
Mohseni, S., Ivarsson, J., Ahl, R., Dogan, S., Saar, S., Reinsoo, A., . . . Talving, P. (2019). Simultaneous common bile duct clearance and laparoscopic cholecystectomy: experience of a one-stage approach. European Journal of Trauma and Emergency Surgery, 45(2), 337-342
Åpne denne publikasjonen i ny fane eller vindu >>Simultaneous common bile duct clearance and laparoscopic cholecystectomy: experience of a one-stage approach
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2019 (engelsk)Inngår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 45, nr 2, s. 337-342Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Introduction: The timing and optimal method for common bile duct (CBD) clearance and laparoscopic cholecystectomy remains controversial. Several different approaches are available in clinical practice. The current study presents the experience of two European hospitals of simultaneous laparoscopic cholecystectomy (LC) and intra-operative endoscopic retrograde cholangiopacreatography (IO-ERCP) done by surgeons.

Methods: Retrospective analysis of all consecutive patients subjected to LC+IO-ERCP during their index admission between 4/2014 and 9/2016. Data accrued included patient demographics, laboratory markers, operation time (min) reported as mean (SD) and hospital length of stay (LOS) reported as median (lower quartile, upper quartile).

Results: During the 29-month study, a total of 201 consecutive LC+IO-ERCPs were performed. The mean age of patients was 55 +/- 19years and 67% were female. The mean intervention time was 105 +/- 44min. The total LOS was 4 (3, 7) days and the post-operative LOS was 2 (1, 3)days. A total of 6 (3%) patients experienced post-interventional pancreatitis and two (1%) patients suffered a Strasberg type A bile leak. All patients were successfully discharged.

Conclusion: Simultaneous LC+IO-ERCP is associated with few complications. Further studies investigating cost-benefit and patient satisfaction are warranted.

sted, utgiver, år, opplag, sider
Springer Berlin/Heidelberg, 2019
Emneord
Laparoscopic cholecystectomy, ERCP, One-stage approach
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-73874 (URN)10.1007/s00068-018-0921-z (DOI)000463718800020 ()29417182 (PubMedID)2-s2.0-85041502184 (Scopus ID)
Tilgjengelig fra: 2019-04-23 Laget: 2019-04-23 Sist oppdatert: 2019-04-23bibliografisk kontrollert
Ahl, R., Sarani, B., Sjölin, G. & Mohseni, S. (2019). The Association of Intracranial Pressure Monitoring and Mortality: A Propensity Score-Matched Cohort of Isolated Severe Blunt Traumatic Brain Injury. Journal of Emergencies, Trauma and Shock, 12(1), 18-22
Åpne denne publikasjonen i ny fane eller vindu >>The Association of Intracranial Pressure Monitoring and Mortality: A Propensity Score-Matched Cohort of Isolated Severe Blunt Traumatic Brain Injury
2019 (engelsk)Inngår i: Journal of Emergencies, Trauma and Shock, ISSN 0974-2700, E-ISSN 0974-519X, Vol. 12, nr 1, s. 18-22Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Intracranial pressure (ICP) monitoring in traumatic brain injury (TBI) is common. Yet, its efficacy varies between studies, and the actual effect on the outcome is debated. This study investigates the association of ICP monitoring and clinical outcome in patients with an isolated severe blunt TBI.

Patients and Methods: Patients were recruited from the American College of Surgeons-Trauma Quality Improvement Program database during 2014. Inclusion criteria were limited to adult patients (>= 18 years) who had a sustained isolated severe intracranial injury (Abbreviated Injury Scale [AIS] head of >= 3 and Glasgow Coma Scale [GCS] of <= 8) following blunt trauma to the head. Patients with AIS score >0 for any extracranial body area were excluded. Patients' demographics, injury characteristics, interventions, and outcomes were collected for analysis. Patients receiving ICP monitoring were matched in a 1:1 ratio with controls who were not ICP monitored using propensity score matching.

Results: A total of 3289 patients met inclusion criteria. Of these, 601 (18.3%) were ICP monitored. After propensity score matching, 557 pairs were available for analysis with a mean age of 44 (standard deviation 18) years and 80.2% of them were male. Median GCS on admission was 4[3,7], and a third of patients required neurosurgical intervention. There were no statistical differences in any variables included in the analysis between the ICP-monitored group and their matched counterparts. ICP-monitored patients required significantly longer intensive care unit and hospital length of stay and had an increased mortality risk with odds ratio of 1.6 (95% confidence interval: 1.1-2.5, P = 0.038).

Conclusion: ICP monitoring is associated with increased in-hospital mortality in patients with an isolated severe TBI. Further investigation into which patients may benefit from this intervention is required.

sted, utgiver, år, opplag, sider
Wolters Kluwer, 2019
Emneord
Intracranial pressure monitoring, mortality, traumatic brain injury
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-74288 (URN)000465973700004 ()31057279 (PubMedID)2-s2.0-85064845093 (Scopus ID)
Tilgjengelig fra: 2019-05-15 Laget: 2019-05-15 Sist oppdatert: 2019-10-08bibliografisk kontrollert
Ahl, R., Matthiessen, P., Cao, Y., Sjölin, G., Ljungqvist, O. & Mohseni, S. (2019). The Relationship Between Severe Complications, Beta-Blocker Therapy and Long-Term Survival Following Emergency Surgery for Colon Cancer. World Journal of Surgery, 43(10), 2527-2535
Åpne denne publikasjonen i ny fane eller vindu >>The Relationship Between Severe Complications, Beta-Blocker Therapy and Long-Term Survival Following Emergency Surgery for Colon Cancer
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2019 (engelsk)Inngår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, nr 10, s. 2527-2535Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Emergency surgery for colon cancer carries significant morbidity, and studies show more than doubled mortality when comparing elective to emergency surgery. The relationship between postoperative complications and survival has been outlined. Beta-blocker therapy has been linked to improved postoperative outcomes. This study aims to assess the impact of postoperative complications on long-term survival following emergency surgery for colon cancer and to determine whether beta-blockade can reduce complications.

STUDY DESIGN: This cohort study utilized the prospective Swedish Colorectal Cancer Registry to identify adults undergoing emergency colon cancer surgery between 2011 and 2016. Prescription data for preoperative beta-blocker therapy were collected from the national drug registry. Cox regression was used to evaluate the effect of beta-blocker exposure and complications on 1-year mortality, and Poisson regression was used to evaluate beta-blocker exposure in patients with major complications.

RESULTS: A total of 3139 patients were included with a mean age of 73.1 [12.4] of which 671 (21.4%) were prescribed beta-blockers prior to surgery. Major complications occurred in 375 (11.9%) patients. Those suffering major complications showed a threefold increase in 1-year mortality (adjusted HR = 3.29; 95% CI 2.75-3.94; p < 0.001). Beta-blocker use was linked to a 60% risk reduction in 1-year mortality (adjusted HR = 0.40; 95% CI 0.26-0.62; p < 0.001) but did not show a statistically significant association with reductions in major complications (adjusted IRR = 0.77; 95% CI 0.59-1.00; p = 0.055).

CONCLUSION: The development of major complications after emergency colon cancer surgery is associated with increased mortality during one year after surgery. Beta-blocker therapy may protect against postoperative complications.

sted, utgiver, år, opplag, sider
Springer, 2019
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-74752 (URN)10.1007/s00268-019-05058-z (DOI)000483827100021 ()31214833 (PubMedID)2-s2.0-85067787288 (Scopus ID)
Tilgjengelig fra: 2019-06-20 Laget: 2019-06-20 Sist oppdatert: 2019-09-20bibliografisk kontrollert
Mohseni, S., Holzmacher, J., Sjölin, G., Ahl, R. & Sarani, B. (2018). Outcomes after resection versus non-resection management of penetrating grade III and IV pancreatic injury: A trauma quality improvement (TQIP) databank analysis. Injury, 49(1), 27-32
Åpne denne publikasjonen i ny fane eller vindu >>Outcomes after resection versus non-resection management of penetrating grade III and IV pancreatic injury: A trauma quality improvement (TQIP) databank analysis
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2018 (engelsk)Inngår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 49, nr 1, s. 27-32Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: High-grade traumatic pancreatic injuries are associated with significant morbidity and mortality. Non-resection management is associated with fewer complications in pediatric patients. The present study evaluates outcomes following resection versus non-resection management of severe pancreatic injury caused by penetrating trauma.

METHODS: A retrospective study of the Trauma Quality Improvement Program (TQIP) database was performed from 1/2010 to 12/2014. Patients with AAST Organ Injury Scale pancreatic grade III and IV injuries caused by penetrating trauma were included in the study. Demographics, vital signs on admission, Abbreviated Injury Scale per body region, Injury Severity Score, transfusion and therapeutic modality were obtained. Mortality, length of stay (LOS), pseudocyst, pancreatitis, sepsis, thromboembolism, renal failure, ARDS and unplanned ICU admission or re-operation were stratified according to injury grade and treatment modality. Patients were stratified into those who did/did not undergo pancreatic resection.

RESULTS: A total of 4,098 patients had a pancreatic injury of which 15.9% (n=653) had a grade III and 6.7% (n=274) a grade IV pancreatic injury. There were no differences in patient demographics or overall injury severity between the resected and non-resected cohorts within each pancreatic injury grade. Forty-two percent of grade III and 38.0% of grade IV injuries underwent pancreatic resection. The total LOS was longer in the resection arm irrespective of pancreatic injury severity. There was no significant difference in morbidity between cohorts. Similarly, mortality was not significantly different between the two management approaches for grade III: 15.1% (95% CI 11.0-19.9) vs. 18.4% (95% CI 14.6-22.6), p=0.32 and grade IV: 24.0% (95% CI: 16.2-33.4) vs. 27.1% (95% CI: 20.5-34.4), p=0.68.

CONCLUSION: Resection for treatment of grade III and IV pancreatic injury is not associated with a significant decrease in mortality but is associated with an increase in hospital LOS.

sted, utgiver, år, opplag, sider
Elsevier, 2018
Emneord
Pancreas, Pancreatic injury, Pancreatic resection
HSV kategori
Identifikatorer
urn:nbn:se:oru:diva-63030 (URN)10.1016/j.injury.2017.11.021 (DOI)000422767800005 ()29173964 (PubMedID)2-s2.0-85034656834 (Scopus ID)
Tilgjengelig fra: 2017-12-07 Laget: 2017-12-07 Sist oppdatert: 2018-08-16bibliografisk kontrollert
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