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RISS 인기검색어
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- 저자 : James Dixon (검색결과 2 건)
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Surgical Rib Fracture Fixation: Early Operative Intervention Improves Outcomes
James Dixon,Iain Rankin,Nicholas Diston,Joaquim Goffin,Iain Stevenson 대한심장혈관흉부외과학회 2024 Journal of Chest Surgery (J Chest Surg) Vol.57 No.2
Background: This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or nonoperative management at our major trauma center. Methods: A retrospective review of all patients who were considered for surgical stabilization of rib fractures (SSRF) at a single major trauma center from May 2016 to September 2022 was performed. Results: In total, 352 patients with complex rib fractures were identified. Thirty-seven patients (11%) fulfilled the criteria for surgical management and underwent SSRF. The SSRF group had a significantly higher proportion of patients with flail chest (32 [86%] vs. 94 [27%], p<0.001) or Injury Severity Score (ISS) >15 (37 [100%] vs. 129 [41%], p<0.001). No significant differences were seen between groups for 1-year mortality. Patients who underwent SSRF within 72 hours were 6 times less likely to develop pneumonia than those in whom SSRF was delayed for over 72 hours (2 [18%] vs. 15 [58%]; odds ratio, 0.163; 95% confidence interval, 0.029–0.909; p=0.036). Prompt SSRF showed non-significant associations with shorter intensive care unit length of stay (6 days vs. 10 days, p=0.140) and duration of mechanical ventilation (5 days vs. 8 days, p=0.177). SSRF was associated with a longer hospital length of stay compared to nonoperative patients with flail chest and/or ISS >15 (19 days vs. 13 days, p=0.012), whilst SSRF within 72 hours was not. Conclusion: Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Delayed surgical fixation was associated with increased rates of pneumonia and a longer hospital length of stay.
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Edward John Nevins,James Edward Dixon,Yirupaiahgari Krishnaiah Setty Viswanath 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4
Background/Aims: STRETTA improves the quality of life and reduces the need for anti-reflux medication in select patients,especially those with uncomplicated gastroesophageal reflux disease (GERD). We aimed to review the outcomes of STRETTA inpatients with medically refractory GERD, who had undergone previous gastric surgery. Methods: This was a review of a prospective database in a British center. Since 2016, all GERD patients who underwent STRETTAand had a history of previous gastric surgery were studied (n=11). Anti-reflux medication pre- and post-STRETTA was evaluated. The outcomes were assessed objectively by the change in anti-reflux medication and subjectively through a pre- and post-procedureGERD-health-related quality of life (HRQL) questionnaire. Results: The median length of follow-up was 23 months. Nine patients demonstrated improved GERD-HRQL scoresfollowing STRETTA (82%). Of the 7 patients who underwent fundoplication, all reported improved symptoms, with 3 patientsdiscontinuing the medication and 3 patients on a reduced dose of proton pump inhibitor. Four patients underwent surgery otherthan fundoplication, of which 2 reported improvement and discontinued the proton pump inhibitor. Two patients reported noimprovement. Conclusions: This study demonstrates that STRETTA is successful in reducing refractory GERD in patients with previous gastricsurgery. The outcomes were comparable to published outcomes in patients with uncomplicated GERD with no previous history ofgastric surgery.
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