The Experts below are selected from a list of 3651066 Experts worldwide ranked by ideXlab platform
John F. Gibbs - One of the best experts on this subject based on the ideXlab platform.
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The introducer technique is the optimal method for placing percutaneous endoscopic gastrostomy tubes in head and neck cancer patients
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Jason M. Foster, H Nava, Peter Filocamo, Nestor Rigual, Thom Loree, Judy Smith, W. Hicks, Michael Schiff, John F. GibbsAbstract:BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes are often placed in head and neck cancer patients to provide nutritional support, but studies have found the Complication rates to be higher than other subsets of patients who undergo PEG placement. Complication rates as high as 50% have been reported, with the bulk of these Complications being PEG site issues (i.e., cellulitis, abscess, fascitis, and tumor implantation). Because the pull technique has been the primary technique used, the theory is that the transoral tube passage is the source of the Complications in these patients. Alternatively, the introducer technique uses a transabdominal approach to place the device, avoiding any tube contamination by upper aerodigestive organisms or tumor cells. At our institution, this technique has been used exclusively for head and neck cancer patients and this article reports our experience. METHODS: One hundred forty-nine head and neck cancer patients who had a prophylactic PEG tube placed were reviewed from January 1, 1999 to December 31, 2003. The rates of placement success, morbidity, and Complications were determined. RESULTS: Successful placement was achieved in 148 (99%) patients without any PEG-related deaths. Overall, 17 Complications (11%) occurred, with only one major Complication (0.7%) identified. PEG site infections were uncommon with only five cases (3.4%) and all were mild cellulitis. CONCLUSIONS: The introducer technique is the safest method for PEG tube placement in head and neck cancer patients. The overall rate of Complications is low and PEG site infectious Complications are rare. The introducer technique should be the method of choice for PEG tubes in head and neck cancer patients.
Jason M. Foster - One of the best experts on this subject based on the ideXlab platform.
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The introducer technique is the optimal method for placing percutaneous endoscopic gastrostomy tubes in head and neck cancer patients
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Jason M. Foster, H Nava, Peter Filocamo, Nestor Rigual, Thom Loree, Judy Smith, W. Hicks, Michael Schiff, John F. GibbsAbstract:BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes are often placed in head and neck cancer patients to provide nutritional support, but studies have found the Complication rates to be higher than other subsets of patients who undergo PEG placement. Complication rates as high as 50% have been reported, with the bulk of these Complications being PEG site issues (i.e., cellulitis, abscess, fascitis, and tumor implantation). Because the pull technique has been the primary technique used, the theory is that the transoral tube passage is the source of the Complications in these patients. Alternatively, the introducer technique uses a transabdominal approach to place the device, avoiding any tube contamination by upper aerodigestive organisms or tumor cells. At our institution, this technique has been used exclusively for head and neck cancer patients and this article reports our experience. METHODS: One hundred forty-nine head and neck cancer patients who had a prophylactic PEG tube placed were reviewed from January 1, 1999 to December 31, 2003. The rates of placement success, morbidity, and Complications were determined. RESULTS: Successful placement was achieved in 148 (99%) patients without any PEG-related deaths. Overall, 17 Complications (11%) occurred, with only one major Complication (0.7%) identified. PEG site infections were uncommon with only five cases (3.4%) and all were mild cellulitis. CONCLUSIONS: The introducer technique is the safest method for PEG tube placement in head and neck cancer patients. The overall rate of Complications is low and PEG site infectious Complications are rare. The introducer technique should be the method of choice for PEG tubes in head and neck cancer patients.
Scott Segal - One of the best experts on this subject based on the ideXlab platform.
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serious Complications related to obstetric anesthesia the serious Complication repository project of the society for obstetric anesthesia and perinatology
Anesthesiology, 2014Co-Authors: Robert Dangelo, Richard M Smiley, Edward T Riley, Scott SegalAbstract:BACKGROUND: Because of the lack of large obstetric anesthesia databases, the incidences of serious Complications related to obstetric anesthesia remain unknown. The Society for Obstetric Anesthesia and Perinatology developed the Serious Complication Repository Project to establish the incidence of serious Complications related to obstetric anesthesia and to identify risk factors associated with each. METHODS: Serious Complications were defined by the Society for Obstetric Anesthesia and Perinatology Research Committee which also coordinated the study. Thirty institutions participated in the approximately 5-yr study period. Data were collected as part of institutional quality assurance and sent to the central project coordinator quarterly. RESULTS: Data were captured on more than 257,000 anesthetics, including 5,000 general anesthetics for cesarean delivery. There were 157 total serious Complications reported, 85 of which were anesthesia related. High neuraxial block, respiratory arrest in labor and delivery, and unrecognized spinal catheter were the most frequent Complications encountered. A serious Complication occurs in approximately 1:3,000 (1:2,443 to 1:3,782) obstetric anesthetics. CONCLUSIONS: The Serious Complication Repository Project establishes the incidence of serious Complications in obstetric anesthesia. Because serious Complications related to obstetric anesthesia are rare, there were too few Complications in each category to identify risk factors associated with each. However, because many of these Complications can lead to catastrophic outcomes, it is recommended that the anesthesia provider remains vigilant and be prepared to rapidly diagnose and treat any Complication.
Didier A Mandelbrot - One of the best experts on this subject based on the ideXlab platform.
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nature timing and severity of Complications from ultrasound guided percutaneous renal transplant biopsy
Transplant International, 2016Co-Authors: Robert R Redfield, Kasi R Mccune, Elizabeth A Sadowski, Meghan E Hanson, Amanda J Kolterman, Jessica B Robbins, Kristie Guite, Maha Mohamed, Sandesh Parajuli, Didier A MandelbrotAbstract:Summary We sought to review our kidney transplant biopsy experience to assess the incidence, type, presenting symptoms, and timing of renal transplant biopsy Complications, as well as determine any modifiable risk factors for postbiopsy Complications. This is an observational analysis of patients at the University of Wisconsin between January 1, 2000, and December 31, 2009. Patients with an INR ≥1.5 or platelet counts less than 50 000 were not biopsied. An 18-gauge needle was used for biopsy. Over the study period, 3738 biopsies were performed with 66 Complications (1.8%). No deaths occurred. A total of 0.7% were mild Complications, 0.7% were moderate Complications, 0.21% were severe Complications, and 0.19% were life-threatening. Most Complications occurred within the 4-h postbiopsy period, although serious Complications were often delayed: 67% of Complications requiring surgical intervention presented greater than 4 h after biopsy. Biopsy within 1 week of transplant had a 311% increased risk of a Complication. Postbiopsy reduction in hematocrit and hemoglobin at 4 h was associated with a Complication. In conclusion, life-threatening Complications after renal allograft biopsy occurred in 0.19% of patients. Most Complications occurred within 4 h postprocedure; however, many serious Complications occurred with a time delay after initially uneventful monitoring. The only clinically significant laboratory predictor of a Complication was a fall in the hematocrit or hemoglobin within 4 h. Patients biopsied within a week of transplant were at the highest risk for a Complication and should therefore be most closely monitored.
William J Gaynor - One of the best experts on this subject based on the ideXlab platform.
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seminal postoperative Complications and mode of death after pediatric cardiac surgical procedures
The Annals of Thoracic Surgery, 2016Co-Authors: Michael Gaies, Sara K Pasquali, Janet E Donohue, Justin B Dimick, Sarah Limbach, Nancy Burnham, Chitra Ravishankar, Richard G Ohye, William J Gaynor, Christopher E MascioAbstract:Background Understanding the seminal Complications leading to death after pediatric cardiac surgical procedures may provide opportunities to reduce mortality. This study analyzed all deaths at two pediatric cardiac surgical programs and developed a method to identify the seminal Complications and modes of death. Methods Trained nurses abstracted all cases of in-hospital mortality meeting inclusion criteria from each site over 5 years (2008 to 2012). Complication definitions were consistent with those of a multicenter clinical registry. An adjudication committee assigned a seminal Complication in each case (the Complication initiating the cascade of events leading to death). Seminal Complications were grouped into categories to designate "mode of death." The epidemiology of seminal Complications and of mode of death was described. Results In 191 subjects, low cardiac output syndrome (71% of all subjects), cardiac arrest (52%), and arrhythmia (48%) were the most common Complications. The committee assigned low cardiac output syndrome (30%), failure to separate from bypass (16%), and cardiac arrest (12%) most frequently as seminal Complications. Seminal Complications occurred a median 2 hours (interquartile range [IQR], 0 to 35 hours) postoperatively. Patients experienced a median of seven (IQR, 3 to 12) additional Complications before death at a median of 15 days (IQR, 4 to 46). Systemic circulatory failure was the most common mode of death (51%), followed by inadequate pulmonary blood flow (13%) and cardiac arrest (12%). Conclusions Seminal Complications occurred early postoperatively, and systemic circulatory failure was the most common mode of death. Our classification system is likely scalable for subsequent multicenter analysis to understand cause-specific mortality variation across hospitals and to drive quality improvement.
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evaluation of failure to rescue as a quality metric in pediatric heart surgery an analysis of the sts congenital heart surgery database
The Annals of Thoracic Surgery, 2012Co-Authors: Sara K Pasquali, Xia He, Jeffrey P Jacobs, Marshall L Jacobs, Sean M Obrien, William J GaynorAbstract:Background Failure to rescue (FTR; the probability of death after a Complication) has been adopted as a quality metric in adult cardiac surgery, in which it has been shown that high-performing centers with low mortality rates do not have fewer Complications, but rather lower mortality in those who experience a Complication (lower FTR). It is unknown whether this holds true in pediatric heart surgery. We characterized the relationship between Complications, FTR, and mortality in this population. Methods Children (0 to 18 years) undergoing heart surgery at centers participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2006 to 2009) were included. Outcomes were examined in multivariable analysis adjusting for patient characteristics, surgical risk category, and within-center clustering. Results This study included 40,930 patients from 72 centers. Overall in-hospital mortality was 3.7%, 39.3% had a postoperative Complication, and the FTR rate (number of deaths in those with a Complication) was 9.1%. When hospitals were characterized by in-hospital mortality rate, there was no difference across hospital mortality tertiles in the Complication rate in adjusted analysis; however, hospitals in the lowest mortality tertile had significantly lower FTR rates (6.6% versus 12.4%; p Conclusions This analysis suggests that hospitals with low mortality rates do not have fewer Complications after pediatric heart surgery, but instead have lower mortality in those who experience a Complication (lower FTR). Further investigation into FTR as a quality metric in pediatric heart surgery is warranted.
