The Experts below are selected from a list of 37818 Experts worldwide ranked by ideXlab platform
Bahaeddine M Sibai - One of the best experts on this subject based on the ideXlab platform.
-
pfannenstiel versus vertical Skin Incision for cesarean delivery in women with class iii obesity a randomized trial
American Journal of Perinatology, 2019Co-Authors: Caroline Marrs, Sean C Blackwell, George R. Saade, Ashley E Hester, Gayle Olson, Jonathan Faro, Claudia Pedroza, Bahaeddine M SibaiAbstract:Objective To compare Pfannenstiel versus vertical Skin Incision for the prevention of cesarean wound complications in morbidly obese women. Study Design Women with body mass index ≥ 40 kg/m2 undergoing cesarean delivery (CD) were randomly allocated to Pfannenstiel or vertical Skin Incision. The primary outcome was a wound complication within 6 weeks. Due to a low consent rate, we limited enrollment to a defined time period for feasibility. We conducted a traditional frequentist analysis with log-binomial regression to obtain relative risks (RRs), and a Bayesian analysis to estimate the probability of treatment benefit. A priori, we decided that a ≥60% probability of treatment benefit for either Incision type would be convincing evidence to pursue a larger trial. Results A total of 648 women were approached, 228 were consented, and 91 were randomized. The primary outcome rate was 19% in the Pfannenstiel group and 21% in the vertical group (RR: 1.18; 95% confidence interval: 0.49–2.85). Bayesian analysis revealed a 59% probability that Pfannenstiel had a lower primary outcome rate. Conclusion In the first published randomized trial to compare Skin Incision types for obese women undergoing CD, we were unable to demonstrate differences in clinical outcomes. Our trial suggests that a larger study would have a low probability for different findings. Trial Registration NCT 01897376 ( www.clinicaltrials.gov ).
-
removal notice to the relationship between primary cesarean delivery Skin Incision type and wound complications in women with morbid obesity am j obstet gynecol 2014 210 319 e1 4
American Journal of Obstetrics and Gynecology, 2017Co-Authors: Caroline Marrs, Hind N Moussa, Bahaeddine M Sibai, Sean C BlackwellAbstract:This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been removed at the request of the Editors-in-Chief and Authors. The original publication reported that univariate analysis showed that a vertical Skin Incision in obese women undergoing Cesarean delivery was associated with a higher odds ratio for wound complications than a transverse Skin Incision. Multivariable analyses showed a reversal of the association (i.e. the odds of wound complications were lower in women with a vertical Skin Incision). However, there was an error in the way the variable was entered in the logistic analysis. Re-analysis with the correct coding of the variable indicates that a transverse Skin Incision is associated with decreased odds of wound complication compared to a vertical Skin Incision.
-
the relationship between primary cesarean delivery Skin Incision type and wound complications in women with morbid obesity
American Journal of Obstetrics and Gynecology, 2014Co-Authors: Caroline Marrs, Hind N Moussa, Bahaeddine M Sibai, Sean C BlackwellAbstract:OBJECTIVE: We sought to evaluate the relationship between Skin Incision, transverse or vertical, and the development of wound complications in women with morbid obesity requiring primary cesarean delivery (CD). STUDY DESIGN: Morbidly obese women (body mass index � 40 kg/m 2 ) undergoing primary CD at � 24 weeks’ gestation were studied in a secondary analysis of a multicenter registry. Clinical characteristics and outcomes were compared between women who had transverse vs vertical Skin Incision. The primary outcome was composite wound complication (infection, seroma, hematoma, evisceration, fascial dehiscence) and composite adverse maternal outcome (transfusion, hysterectomy, organ injury, coagulopathy, thromboembolic event, pulmonary edema, death). Multivariable logistic regression analyses were performed to adjust for confounding factors. RESULTS: In all, 3200 women were studied: 2603 (81%) had a transverse Incision and 597 (19%) had a vertical Incision. Vertical Skin Incision was associated with lower risk for wound complications (adjusted odds ratio, 0.32; 95% confidence interval, 0.17e0.62; P<.001)but notwith compositeadversematernaloutcome(adjusted odds ratio, 0.72; 95% confidence interval, 0.41e1.25; P ¼ .24). CONCLUSION: In morbidly obese women undergoing a primary CD, vertical Skin Incision was associated with a lower wound complication rate. Due to the selection bias associated with utilization of Skin Incision type and the observational nature of this study, a randomized controlled trial is necessary to answer this clinical question.
-
The relationship between primary cesarean delivery Skin Incision type and wound complications in women with morbid obesity
American journal of obstetrics and gynecology, 2014Co-Authors: Caroline C. Marrs, Hind N Moussa, Bahaeddine M Sibai, Sean C BlackwellAbstract:OBJECTIVE: We sought to evaluate the relationship between Skin Incision, transverse or vertical, and the development of wound complications in women with morbid obesity requiring primary cesarean delivery (CD). STUDY DESIGN: Morbidly obese women (body mass index � 40 kg/m 2 ) undergoing primary CD at � 24 weeks’ gestation were studied in a secondary analysis of a multicenter registry. Clinical characteristics and outcomes were compared between women who had transverse vs vertical Skin Incision. The primary outcome was composite wound complication (infection, seroma, hematoma, evisceration, fascial dehiscence) and composite adverse maternal outcome (transfusion, hysterectomy, organ injury, coagulopathy, thromboembolic event, pulmonary edema, death). Multivariable logistic regression analyses were performed to adjust for confounding factors. RESULTS: In all, 3200 women were studied: 2603 (81%) had a transverse Incision and 597 (19%) had a vertical Incision. Vertical Skin Incision was associated with lower risk for wound complications (adjusted odds ratio, 0.32; 95% confidence interval, 0.17e0.62; P
Sean C Blackwell - One of the best experts on this subject based on the ideXlab platform.
-
pfannenstiel versus vertical Skin Incision for cesarean delivery in women with class iii obesity a randomized trial
American Journal of Perinatology, 2019Co-Authors: Caroline Marrs, Sean C Blackwell, George R. Saade, Ashley E Hester, Gayle Olson, Jonathan Faro, Claudia Pedroza, Bahaeddine M SibaiAbstract:Objective To compare Pfannenstiel versus vertical Skin Incision for the prevention of cesarean wound complications in morbidly obese women. Study Design Women with body mass index ≥ 40 kg/m2 undergoing cesarean delivery (CD) were randomly allocated to Pfannenstiel or vertical Skin Incision. The primary outcome was a wound complication within 6 weeks. Due to a low consent rate, we limited enrollment to a defined time period for feasibility. We conducted a traditional frequentist analysis with log-binomial regression to obtain relative risks (RRs), and a Bayesian analysis to estimate the probability of treatment benefit. A priori, we decided that a ≥60% probability of treatment benefit for either Incision type would be convincing evidence to pursue a larger trial. Results A total of 648 women were approached, 228 were consented, and 91 were randomized. The primary outcome rate was 19% in the Pfannenstiel group and 21% in the vertical group (RR: 1.18; 95% confidence interval: 0.49–2.85). Bayesian analysis revealed a 59% probability that Pfannenstiel had a lower primary outcome rate. Conclusion In the first published randomized trial to compare Skin Incision types for obese women undergoing CD, we were unable to demonstrate differences in clinical outcomes. Our trial suggests that a larger study would have a low probability for different findings. Trial Registration NCT 01897376 ( www.clinicaltrials.gov ).
-
removal notice to the relationship between primary cesarean delivery Skin Incision type and wound complications in women with morbid obesity am j obstet gynecol 2014 210 319 e1 4
American Journal of Obstetrics and Gynecology, 2017Co-Authors: Caroline Marrs, Hind N Moussa, Bahaeddine M Sibai, Sean C BlackwellAbstract:This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been removed at the request of the Editors-in-Chief and Authors. The original publication reported that univariate analysis showed that a vertical Skin Incision in obese women undergoing Cesarean delivery was associated with a higher odds ratio for wound complications than a transverse Skin Incision. Multivariable analyses showed a reversal of the association (i.e. the odds of wound complications were lower in women with a vertical Skin Incision). However, there was an error in the way the variable was entered in the logistic analysis. Re-analysis with the correct coding of the variable indicates that a transverse Skin Incision is associated with decreased odds of wound complication compared to a vertical Skin Incision.
-
the relationship between primary cesarean delivery Skin Incision type and wound complications in women with morbid obesity
American Journal of Obstetrics and Gynecology, 2014Co-Authors: Caroline Marrs, Hind N Moussa, Bahaeddine M Sibai, Sean C BlackwellAbstract:OBJECTIVE: We sought to evaluate the relationship between Skin Incision, transverse or vertical, and the development of wound complications in women with morbid obesity requiring primary cesarean delivery (CD). STUDY DESIGN: Morbidly obese women (body mass index � 40 kg/m 2 ) undergoing primary CD at � 24 weeks’ gestation were studied in a secondary analysis of a multicenter registry. Clinical characteristics and outcomes were compared between women who had transverse vs vertical Skin Incision. The primary outcome was composite wound complication (infection, seroma, hematoma, evisceration, fascial dehiscence) and composite adverse maternal outcome (transfusion, hysterectomy, organ injury, coagulopathy, thromboembolic event, pulmonary edema, death). Multivariable logistic regression analyses were performed to adjust for confounding factors. RESULTS: In all, 3200 women were studied: 2603 (81%) had a transverse Incision and 597 (19%) had a vertical Incision. Vertical Skin Incision was associated with lower risk for wound complications (adjusted odds ratio, 0.32; 95% confidence interval, 0.17e0.62; P<.001)but notwith compositeadversematernaloutcome(adjusted odds ratio, 0.72; 95% confidence interval, 0.41e1.25; P ¼ .24). CONCLUSION: In morbidly obese women undergoing a primary CD, vertical Skin Incision was associated with a lower wound complication rate. Due to the selection bias associated with utilization of Skin Incision type and the observational nature of this study, a randomized controlled trial is necessary to answer this clinical question.
-
The relationship between primary cesarean delivery Skin Incision type and wound complications in women with morbid obesity
American journal of obstetrics and gynecology, 2014Co-Authors: Caroline C. Marrs, Hind N Moussa, Bahaeddine M Sibai, Sean C BlackwellAbstract:OBJECTIVE: We sought to evaluate the relationship between Skin Incision, transverse or vertical, and the development of wound complications in women with morbid obesity requiring primary cesarean delivery (CD). STUDY DESIGN: Morbidly obese women (body mass index � 40 kg/m 2 ) undergoing primary CD at � 24 weeks’ gestation were studied in a secondary analysis of a multicenter registry. Clinical characteristics and outcomes were compared between women who had transverse vs vertical Skin Incision. The primary outcome was composite wound complication (infection, seroma, hematoma, evisceration, fascial dehiscence) and composite adverse maternal outcome (transfusion, hysterectomy, organ injury, coagulopathy, thromboembolic event, pulmonary edema, death). Multivariable logistic regression analyses were performed to adjust for confounding factors. RESULTS: In all, 3200 women were studied: 2603 (81%) had a transverse Incision and 597 (19%) had a vertical Incision. Vertical Skin Incision was associated with lower risk for wound complications (adjusted odds ratio, 0.32; 95% confidence interval, 0.17e0.62; P
Caroline Marrs - One of the best experts on this subject based on the ideXlab platform.
-
the association of Skin Incision placement during cesarean delivery with wound complications in obese women a systematic review and meta analysis
Journal of Maternal-fetal & Neonatal Medicine, 2020Co-Authors: Rebekah Mccurdy, Caroline Marrs, Robert P Strauss, Laura Felder, Gabriele Saccone, Rodney K Edwards, Loralei L Thornburg, Shayna N Conner, Vincenzo BerghellaAbstract:To determine the risk of wound complications by Skin Incision type in obese women undergoing cesarean delivery. Data sources: Electronic databases (MEDLINE, Scopus, and Ovid) were searched from the...
-
pfannenstiel versus vertical Skin Incision for cesarean delivery in women with class iii obesity a randomized trial
American Journal of Perinatology, 2019Co-Authors: Caroline Marrs, Sean C Blackwell, George R. Saade, Ashley E Hester, Gayle Olson, Jonathan Faro, Claudia Pedroza, Bahaeddine M SibaiAbstract:Objective To compare Pfannenstiel versus vertical Skin Incision for the prevention of cesarean wound complications in morbidly obese women. Study Design Women with body mass index ≥ 40 kg/m2 undergoing cesarean delivery (CD) were randomly allocated to Pfannenstiel or vertical Skin Incision. The primary outcome was a wound complication within 6 weeks. Due to a low consent rate, we limited enrollment to a defined time period for feasibility. We conducted a traditional frequentist analysis with log-binomial regression to obtain relative risks (RRs), and a Bayesian analysis to estimate the probability of treatment benefit. A priori, we decided that a ≥60% probability of treatment benefit for either Incision type would be convincing evidence to pursue a larger trial. Results A total of 648 women were approached, 228 were consented, and 91 were randomized. The primary outcome rate was 19% in the Pfannenstiel group and 21% in the vertical group (RR: 1.18; 95% confidence interval: 0.49–2.85). Bayesian analysis revealed a 59% probability that Pfannenstiel had a lower primary outcome rate. Conclusion In the first published randomized trial to compare Skin Incision types for obese women undergoing CD, we were unable to demonstrate differences in clinical outcomes. Our trial suggests that a larger study would have a low probability for different findings. Trial Registration NCT 01897376 ( www.clinicaltrials.gov ).
-
removal notice to the relationship between primary cesarean delivery Skin Incision type and wound complications in women with morbid obesity am j obstet gynecol 2014 210 319 e1 4
American Journal of Obstetrics and Gynecology, 2017Co-Authors: Caroline Marrs, Hind N Moussa, Bahaeddine M Sibai, Sean C BlackwellAbstract:This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been removed at the request of the Editors-in-Chief and Authors. The original publication reported that univariate analysis showed that a vertical Skin Incision in obese women undergoing Cesarean delivery was associated with a higher odds ratio for wound complications than a transverse Skin Incision. Multivariable analyses showed a reversal of the association (i.e. the odds of wound complications were lower in women with a vertical Skin Incision). However, there was an error in the way the variable was entered in the logistic analysis. Re-analysis with the correct coding of the variable indicates that a transverse Skin Incision is associated with decreased odds of wound complication compared to a vertical Skin Incision.
-
the relationship between primary cesarean delivery Skin Incision type and wound complications in women with morbid obesity
American Journal of Obstetrics and Gynecology, 2014Co-Authors: Caroline Marrs, Hind N Moussa, Bahaeddine M Sibai, Sean C BlackwellAbstract:OBJECTIVE: We sought to evaluate the relationship between Skin Incision, transverse or vertical, and the development of wound complications in women with morbid obesity requiring primary cesarean delivery (CD). STUDY DESIGN: Morbidly obese women (body mass index � 40 kg/m 2 ) undergoing primary CD at � 24 weeks’ gestation were studied in a secondary analysis of a multicenter registry. Clinical characteristics and outcomes were compared between women who had transverse vs vertical Skin Incision. The primary outcome was composite wound complication (infection, seroma, hematoma, evisceration, fascial dehiscence) and composite adverse maternal outcome (transfusion, hysterectomy, organ injury, coagulopathy, thromboembolic event, pulmonary edema, death). Multivariable logistic regression analyses were performed to adjust for confounding factors. RESULTS: In all, 3200 women were studied: 2603 (81%) had a transverse Incision and 597 (19%) had a vertical Incision. Vertical Skin Incision was associated with lower risk for wound complications (adjusted odds ratio, 0.32; 95% confidence interval, 0.17e0.62; P<.001)but notwith compositeadversematernaloutcome(adjusted odds ratio, 0.72; 95% confidence interval, 0.41e1.25; P ¼ .24). CONCLUSION: In morbidly obese women undergoing a primary CD, vertical Skin Incision was associated with a lower wound complication rate. Due to the selection bias associated with utilization of Skin Incision type and the observational nature of this study, a randomized controlled trial is necessary to answer this clinical question.
Yalda Afshar - One of the best experts on this subject based on the ideXlab platform.
-
Transverse versus vertical Skin Incision for planned cesarean hysterectomy: does it matter?
BMC pregnancy and childbirth, 2020Co-Authors: Alec Szlachta-mcginn, Jenny Y. Mei, Khalil Tabsh, Yalda AfsharAbstract:Author(s): Szlachta-McGinn, Alec; Mei, Jenny; Tabsh, Khalil; Afshar, Yalda | Abstract: BACKGROUND:To investigate differences in perioperative outcomes by type of Skin Incision, transverse versus vertical, for planned cesarean hysterectomy for placenta accreta spectrum (PAS). METHODS:A retrospective cohort study of all women who underwent a planned cesarean hysterectomy for abnormal placentation at a single academic medical center over 5 years. The Student's t-test was used for continuous variables and Fisher's exact test compared categorical variables. Continuous data were presented as median and compared using the Wilcoxon-rank sum test. RESULTS:Forty-two planned cesarean hysterectomies were identified. A transverse Skin Incision was made in 43% (n = 18); a vertical Skin Incision was made in 57% (n = 24). Skin Incision was independent of BMI (30.3 vs 30.8 kg/m2, p = 0.37), placental location (p = 0.82), and PAS-subtype (p = 0.26). Mean estimated blood loss (EBL) was 2.73 l (L) (range 0.5-20) and was not significantly different between transverse and vertical Skin Incision (2.6 L vs 2.8 L, p = 0.8). There was significantly shorter operative time with transverse Skin Incision (180 vs 238 min, p = 0.03), with no difference in intraoperative complications, including cystotomy (p = 0.22) and ureteral injury (p = 0.73). Postoperatively, there was no difference in maternal length of stay (4.8 vs 4.4 days, p = 0.74) or post-operative opioid use (117 vs 180 morphine equivalents, p = 0.31). CONCLUSION:Transverse Skin Incision is associated with shorter operative time for patients undergoing planned cesarean hysterectomy. There was no difference in EBL, intraoperative complications, postoperative length of stay, or opioid use. Given an increasing rate of cesarean hysterectomy, we should consider variables that optimize maternal outcomes and resource utilization.
Cheng-hsi Chang - One of the best experts on this subject based on the ideXlab platform.
-
differentiation of Skin Incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram
Journal of Clinical Monitoring and Computing, 2020Co-Authors: Cheng-hsi Chang, Yue-lin Fang, Yu-jung Wang, Yu-ting LinAbstract:Most surgical procedures involve structures deeper than the Skin. However, the difference in surgical noxious stimulation between Skin Incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from Skin Incision and laparoscopic trocar insertion, and their difference. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical Skin Incision (11 mm), umbilical trocar insertion (11 mm), xiphoid Skin Incision (5 mm), xiphoid trocar insertion (5 mm), subcostal Skin Incision (3 mm), and subcostal trocar insertion (3 mm) were investigated. IHR was derived from electrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the statistical performance between indices and the heart rate readings from the patient monitor. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in trocar insertion than Skin Incision (p < 0.001 for tvHF). The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in Skin Incision, but not in laparoscopic trocar insertion. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between Skin Incision and trocar insertion.
-
Differentiation of Skin Incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram
Journal of Clinical Monitoring and Computing, 2019Co-Authors: Cheng-hsi Chang, Yue-lin Fang, Yu-jung Wang, Hau-tieng WuAbstract:Most surgical procedures involve structures deeper than the Skin. However, the difference in surgical noxious stimulation between Skin Incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from Skin Incision and laparoscopic trocar insertion, and their difference. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical Skin Incision (11 mm), umbilical trocar insertion (11 mm), xiphoid Skin Incision (5 mm), xiphoid trocar insertion (5 mm), subcostal Skin Incision (3 mm), and subcostal trocar insertion (3 mm) were investigated. IHR was derived from electrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (P_K) analysis and global pointwise F -test were used to compare the statistical performance between indices and the heart rate readings from the patient monitor. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in trocar insertion than Skin Incision (p
-
Differentiation of Skin Incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram
arXiv: Quantitative Methods, 2019Co-Authors: Cheng-hsi Chang, Yue-lin Fang, Yu-jung Wang, Yu-ting LinAbstract:Background. Most surgical procedures involve structures deeper than the Skin. However, the difference in surgical noxious stimulation between Skin Incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from Skin Incision and laparoscopic trocar insertion. Methods. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical Skin Incision (11 mm), umbilical trocar insertion (11 mm), xiphoid Skin Incision (5 mm), xiphoid trocar insertion (5 mm), subcostal Skin Incision (3 mm), and subcostal trocar insertion (3 mm) were investigated. IHR was derived from electrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the performance between indices and the heart rate readings from the patient monitor. Results. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in trocar insertion than Skin Incision. The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in Skin Incision, but not in laparoscopic trocar insertion. Conclusions. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between Skin Incision and trocar insertion.
