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Health care workers at risk for mild MERS-CoV infections
Health care workers directly caring for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) are more highly predisposed to contracting the virus, but in a milder form than that of their patients, thus making it difficult to diagnose and treat.
In a study published in Emerging Infectious Diseases, health care professionals (HCP) from the King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia, were examined to determine their likelihood for getting MERS-CoV based on their proximity to patients who already had it. 
“Healthcare settings are important amplifiers of transmission,” explained the investigators, led by Basem M. Alraddadi, MD. “Current MERS-CoV infection control recommendations are based on experience with other viruses rather than on a complete understanding of the epidemiology of MERS-CoV transmission.”
Dr. Alraddadi and his coinvestigators identified 363 HCP, all of whom would be placed into one of three cohorts based on the department in which they worked most extensively: the Medical Intensive Care Unit (MICU), the emergency department (ED), and the neurology unit. A total of 292 HCP were ultimately enrolled in the study: 131 in MICU, 127 in ED, and 34 in neurology. After 9 subjects were excluded because of unavailability of serum specimens, 128 MICU, 122 ED, and 33 neurology unit workers remained.
While none of the neurology unit workers contracted the virus, 15 MICU workers (11.7%) and 5 ED workers (4.1%) did, for a total of 20 out of the 250 subjects in those two cohorts (8%). Radiology technicians were the most susceptible, as 5 of 17 (29.4%) got the virus, followed by 13 of 138 nurses (9.4%), 1 of 31 respiratory therapists (3.2%), and 1 of 41 physicians (2.4%).
“HCP who reported always covering their nose and mouth with either a medical mask or N95 respirator had lower risk for infection than did HCP reporting not always or never doing so, [while] those who reported always using N95 respirators for direct patient contact were less likely to be seropositive, a trend that approached statistical significance (P = .07),” the authors noted.
The most frequent symptoms reported by those surveyed were muscle pain, fevers, headaches, dry cough, and shortness of breath. In the 20-case HCP sample, however, 12 subjects (60%) only had mild illness while 3 (15%) were asymptomatic, making it very hard to diagnose and treat their infection. Three subjects (15%) had severe illness, while another two (10%) had moderate illness, meaning they were admitted to hospital but did not require any mechanical ventilation.
“Our study did not identify strong associations with underlying chronic illnesses, most likely because the prevalence of such conditions was low ([less than] 10%) in this population, [but] HCPs with a history of smoking had a risk for infection almost 3 times that of nonsmokers,” the authors wrote (Emerg Infect Dis. 2016 Nov. doi: 10.3201/eid2211.160920).
The Ministry of Health of Saudi Arabia and the Centers for Disease Control and Prevention funded the study. Dr. Alraddadi and his coauthors did not report any disclosures.
Health care workers directly caring for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) are more highly predisposed to contracting the virus, but in a milder form than that of their patients, thus making it difficult to diagnose and treat.
In a study published in Emerging Infectious Diseases, health care professionals (HCP) from the King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia, were examined to determine their likelihood for getting MERS-CoV based on their proximity to patients who already had it.
“Healthcare settings are important amplifiers of transmission,” explained the investigators, led by Basem M. Alraddadi, MD. “Current MERS-CoV infection control recommendations are based on experience with other viruses rather than on a complete understanding of the epidemiology of MERS-CoV transmission.”
Dr. Alraddadi and his coinvestigators identified 363 HCP, all of whom would be placed into one of three cohorts based on the department in which they worked most extensively: the Medical Intensive Care Unit (MICU), the emergency department (ED), and the neurology unit. A total of 292 HCP were ultimately enrolled in the study: 131 in MICU, 127 in ED, and 34 in neurology. After 9 subjects were excluded because of unavailability of serum specimens, 128 MICU, 122 ED, and 33 neurology unit workers remained.
While none of the neurology unit workers contracted the virus, 15 MICU workers (11.7%) and 5 ED workers (4.1%) did, for a total of 20 out of the 250 subjects in those two cohorts (8%). Radiology technicians were the most susceptible, as 5 of 17 (29.4%) got the virus, followed by 13 of 138 nurses (9.4%), 1 of 31 respiratory therapists (3.2%), and 1 of 41 physicians (2.4%).
“HCP who reported always covering their nose and mouth with either a medical mask or N95 respirator had lower risk for infection than did HCP reporting not always or never doing so, [while] those who reported always using N95 respirators for direct patient contact were less likely to be seropositive, a trend that approached statistical significance (P = .07),” the authors noted.
The most frequent symptoms reported by those surveyed were muscle pain, fevers, headaches, dry cough, and shortness of breath. In the 20-case HCP sample, however, 12 subjects (60%) only had mild illness while 3 (15%) were asymptomatic, making it very hard to diagnose and treat their infection. Three subjects (15%) had severe illness, while another two (10%) had moderate illness, meaning they were admitted to hospital but did not require any mechanical ventilation.
“Our study did not identify strong associations with underlying chronic illnesses, most likely because the prevalence of such conditions was low ([less than] 10%) in this population, [but] HCPs with a history of smoking had a risk for infection almost 3 times that of nonsmokers,” the authors wrote (Emerg Infect Dis. 2016 Nov. doi: 10.3201/eid2211.160920).
The Ministry of Health of Saudi Arabia and the Centers for Disease Control and Prevention funded the study. Dr. Alraddadi and his coauthors did not report any disclosures.
Health care workers directly caring for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) are more highly predisposed to contracting the virus, but in a milder form than that of their patients, thus making it difficult to diagnose and treat.
In a study published in Emerging Infectious Diseases, health care professionals (HCP) from the King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia, were examined to determine their likelihood for getting MERS-CoV based on their proximity to patients who already had it.
“Healthcare settings are important amplifiers of transmission,” explained the investigators, led by Basem M. Alraddadi, MD. “Current MERS-CoV infection control recommendations are based on experience with other viruses rather than on a complete understanding of the epidemiology of MERS-CoV transmission.”
Dr. Alraddadi and his coinvestigators identified 363 HCP, all of whom would be placed into one of three cohorts based on the department in which they worked most extensively: the Medical Intensive Care Unit (MICU), the emergency department (ED), and the neurology unit. A total of 292 HCP were ultimately enrolled in the study: 131 in MICU, 127 in ED, and 34 in neurology. After 9 subjects were excluded because of unavailability of serum specimens, 128 MICU, 122 ED, and 33 neurology unit workers remained.
While none of the neurology unit workers contracted the virus, 15 MICU workers (11.7%) and 5 ED workers (4.1%) did, for a total of 20 out of the 250 subjects in those two cohorts (8%). Radiology technicians were the most susceptible, as 5 of 17 (29.4%) got the virus, followed by 13 of 138 nurses (9.4%), 1 of 31 respiratory therapists (3.2%), and 1 of 41 physicians (2.4%).
“HCP who reported always covering their nose and mouth with either a medical mask or N95 respirator had lower risk for infection than did HCP reporting not always or never doing so, [while] those who reported always using N95 respirators for direct patient contact were less likely to be seropositive, a trend that approached statistical significance (P = .07),” the authors noted.
The most frequent symptoms reported by those surveyed were muscle pain, fevers, headaches, dry cough, and shortness of breath. In the 20-case HCP sample, however, 12 subjects (60%) only had mild illness while 3 (15%) were asymptomatic, making it very hard to diagnose and treat their infection. Three subjects (15%) had severe illness, while another two (10%) had moderate illness, meaning they were admitted to hospital but did not require any mechanical ventilation.
“Our study did not identify strong associations with underlying chronic illnesses, most likely because the prevalence of such conditions was low ([less than] 10%) in this population, [but] HCPs with a history of smoking had a risk for infection almost 3 times that of nonsmokers,” the authors wrote (Emerg Infect Dis. 2016 Nov. doi: 10.3201/eid2211.160920).
The Ministry of Health of Saudi Arabia and the Centers for Disease Control and Prevention funded the study. Dr. Alraddadi and his coauthors did not report any disclosures.
Key clinical point:
Major finding: Among workers who actually treated MERS-CoV patients, 20 out of 250 (8%) contracted the virus, while none of the clerical staff or patient transporters did.
Data source: Retrospective, single-center study of 363 health care personnel during May-June 2014.
Disclosures: The Ministry of Health of Saudi Arabia and the Centers for Disease Control and Prevention funded the study. The authors reported no financial disclosures.
Psychiatric patients face inordinately long wait times in emergency departments
Individuals with psychiatric conditions are facing increasingly longer wait times in emergency departments across the country, including children, according to a pair of studies presented by the American College of Emergency Physicians.
“I really started doing this research because of my clinical experience,” explained Suzanne Catherine Lippert, MD, of Stanford (Calif.) University and the lead author of both studies during an Oct. 17 conference call, saying that seeing patients sit in the ED for days prompted her to finally look into this issue.
Patients with bipolar disorder had the highest likelihood of waiting more than 24 hours in the ED, with an odds ratio of 3.7 (95% confidence interval, 1.5-9.4). This was followed by patients with a diagnosis of psychosis, a dual diagnosis of psychiatric disorders, multiple psychiatric diagnoses, or depression. The most common diagnoses were substance abuse, anxiety, and depression, which constituted 41%, 26%, and 23% of the diagnoses, respectively. Patients with psychosis were admitted 34% of the time and transferred 24% of the time; those who self-harmed were admitted 33% of the time and transferred 29% of the time; and patients with bipolar disorder were admitted 29% of the time and transferred 40% of the time. Patients who had either two or three diagnoses were admitted 9% and 10% of the time, respectively.
“Further investigation of the systems affecting these patients, including placement of involuntary holds, availability of ED psychiatric consultants, or outpatient resources would delineate potential intervention points for the care of these vulnerable patients,” Dr. Lippert and her coauthors wrote.
The second study looked at the differences in waiting for care at EDs between psychiatric patients and medical patients. Length of stay was defined the same way it was in the previous study, with disposition meaning either “discharge, admission to medical or psychiatric bed, [or] transfer to any acute facility.” Length of stay was divided into the same three categories as the previous study, too.
Psychiatric patients were more likely than were medical patients to wait more than 6 hours for disposition, regardless of what the disposition itself ended up being, by a rate of 23% vs. 10%. Similarly, 7% of psychiatric patients vs. just 2.3% of medical patients had to wait longer than 12 hours in the ED, while 1.3% of psychiatric had to wait longer than 24 hours, compared with only 0.5% of medical patients. The average length of stay was significantly longer for psychiatric patients: 194 minutes vs. 138 minutes for medical patients (P less than .01).
Additionally, psychiatric patients were more likely to be uninsured, with 22% not having insurance, compared with 15% of medical patients being uninsured. Furthermore, 4.6% of the psychiatric patients’ previous visit to the ED had been within the prior 72 hours, compared with 3.6% of medical patients. A total of 21% of psychiatric patients required admittance, compared with 13% of medical patients, while 11% of psychiatric patients were transferred, compared with just 1.4% of medical patients.
“These results compel us to further investigate the potential causes of prolonged length of stay in psychiatric patients and to further characterize the population of psychiatric patients most at risk of prolonged stays,” Dr. Lippert and her coinvestigators concluded.
ACEP President Rebecca B. Parker, MD, chimed in during the conference call, explaining that a survey of more than 1,700 emergency physicians revealed some “troubling” findings about the state of emergency departments over the last year.
The nation’s dwindling mental health resources are having a direct impact on patients having psychiatric emergencies, including children,” Dr. Parker explained. “These patients are waiting longer for care, especially those patients who require hospitalization.”
Findings of the survey indicate that 48% of ED physicians witness psychiatric patients being “boarded” in their EDs at least once a day while they wait for a bed. Additionally, less than 17% of respondents said their ED has a psychiatrist on call to respond to psychiatric emergencies, with 11.7% responding that they have no psychiatrist on call to deal with such emergencies. And 52% of respondents said the mental health system in their community has gotten noticeably worse in just the last year.
In a separate statement, Dr. Parker voiced outrage about the situation. “Psychiatric patients wait in the emergency department for hours and even days for a bed, which delays the psychiatric care they so desperately need,” she said. “It also leads to delays in care and diminished resources for other emergency patients. The emergency department has become the dumping ground for these vulnerable patients who have been abandoned by every other part of the health care system.”
ACEP presented the findings during its annual meeting in Las Vegas. No funding sources for these studies were disclosed; Dr. Lippert did not report any financial disclosures.
Individuals with psychiatric conditions are facing increasingly longer wait times in emergency departments across the country, including children, according to a pair of studies presented by the American College of Emergency Physicians.
“I really started doing this research because of my clinical experience,” explained Suzanne Catherine Lippert, MD, of Stanford (Calif.) University and the lead author of both studies during an Oct. 17 conference call, saying that seeing patients sit in the ED for days prompted her to finally look into this issue.
Patients with bipolar disorder had the highest likelihood of waiting more than 24 hours in the ED, with an odds ratio of 3.7 (95% confidence interval, 1.5-9.4). This was followed by patients with a diagnosis of psychosis, a dual diagnosis of psychiatric disorders, multiple psychiatric diagnoses, or depression. The most common diagnoses were substance abuse, anxiety, and depression, which constituted 41%, 26%, and 23% of the diagnoses, respectively. Patients with psychosis were admitted 34% of the time and transferred 24% of the time; those who self-harmed were admitted 33% of the time and transferred 29% of the time; and patients with bipolar disorder were admitted 29% of the time and transferred 40% of the time. Patients who had either two or three diagnoses were admitted 9% and 10% of the time, respectively.
“Further investigation of the systems affecting these patients, including placement of involuntary holds, availability of ED psychiatric consultants, or outpatient resources would delineate potential intervention points for the care of these vulnerable patients,” Dr. Lippert and her coauthors wrote.
The second study looked at the differences in waiting for care at EDs between psychiatric patients and medical patients. Length of stay was defined the same way it was in the previous study, with disposition meaning either “discharge, admission to medical or psychiatric bed, [or] transfer to any acute facility.” Length of stay was divided into the same three categories as the previous study, too.
Psychiatric patients were more likely than were medical patients to wait more than 6 hours for disposition, regardless of what the disposition itself ended up being, by a rate of 23% vs. 10%. Similarly, 7% of psychiatric patients vs. just 2.3% of medical patients had to wait longer than 12 hours in the ED, while 1.3% of psychiatric had to wait longer than 24 hours, compared with only 0.5% of medical patients. The average length of stay was significantly longer for psychiatric patients: 194 minutes vs. 138 minutes for medical patients (P less than .01).
Additionally, psychiatric patients were more likely to be uninsured, with 22% not having insurance, compared with 15% of medical patients being uninsured. Furthermore, 4.6% of the psychiatric patients’ previous visit to the ED had been within the prior 72 hours, compared with 3.6% of medical patients. A total of 21% of psychiatric patients required admittance, compared with 13% of medical patients, while 11% of psychiatric patients were transferred, compared with just 1.4% of medical patients.
“These results compel us to further investigate the potential causes of prolonged length of stay in psychiatric patients and to further characterize the population of psychiatric patients most at risk of prolonged stays,” Dr. Lippert and her coinvestigators concluded.
ACEP President Rebecca B. Parker, MD, chimed in during the conference call, explaining that a survey of more than 1,700 emergency physicians revealed some “troubling” findings about the state of emergency departments over the last year.
The nation’s dwindling mental health resources are having a direct impact on patients having psychiatric emergencies, including children,” Dr. Parker explained. “These patients are waiting longer for care, especially those patients who require hospitalization.”
Findings of the survey indicate that 48% of ED physicians witness psychiatric patients being “boarded” in their EDs at least once a day while they wait for a bed. Additionally, less than 17% of respondents said their ED has a psychiatrist on call to respond to psychiatric emergencies, with 11.7% responding that they have no psychiatrist on call to deal with such emergencies. And 52% of respondents said the mental health system in their community has gotten noticeably worse in just the last year.
In a separate statement, Dr. Parker voiced outrage about the situation. “Psychiatric patients wait in the emergency department for hours and even days for a bed, which delays the psychiatric care they so desperately need,” she said. “It also leads to delays in care and diminished resources for other emergency patients. The emergency department has become the dumping ground for these vulnerable patients who have been abandoned by every other part of the health care system.”
ACEP presented the findings during its annual meeting in Las Vegas. No funding sources for these studies were disclosed; Dr. Lippert did not report any financial disclosures.
Individuals with psychiatric conditions are facing increasingly longer wait times in emergency departments across the country, including children, according to a pair of studies presented by the American College of Emergency Physicians.
“I really started doing this research because of my clinical experience,” explained Suzanne Catherine Lippert, MD, of Stanford (Calif.) University and the lead author of both studies during an Oct. 17 conference call, saying that seeing patients sit in the ED for days prompted her to finally look into this issue.
Patients with bipolar disorder had the highest likelihood of waiting more than 24 hours in the ED, with an odds ratio of 3.7 (95% confidence interval, 1.5-9.4). This was followed by patients with a diagnosis of psychosis, a dual diagnosis of psychiatric disorders, multiple psychiatric diagnoses, or depression. The most common diagnoses were substance abuse, anxiety, and depression, which constituted 41%, 26%, and 23% of the diagnoses, respectively. Patients with psychosis were admitted 34% of the time and transferred 24% of the time; those who self-harmed were admitted 33% of the time and transferred 29% of the time; and patients with bipolar disorder were admitted 29% of the time and transferred 40% of the time. Patients who had either two or three diagnoses were admitted 9% and 10% of the time, respectively.
“Further investigation of the systems affecting these patients, including placement of involuntary holds, availability of ED psychiatric consultants, or outpatient resources would delineate potential intervention points for the care of these vulnerable patients,” Dr. Lippert and her coauthors wrote.
The second study looked at the differences in waiting for care at EDs between psychiatric patients and medical patients. Length of stay was defined the same way it was in the previous study, with disposition meaning either “discharge, admission to medical or psychiatric bed, [or] transfer to any acute facility.” Length of stay was divided into the same three categories as the previous study, too.
Psychiatric patients were more likely than were medical patients to wait more than 6 hours for disposition, regardless of what the disposition itself ended up being, by a rate of 23% vs. 10%. Similarly, 7% of psychiatric patients vs. just 2.3% of medical patients had to wait longer than 12 hours in the ED, while 1.3% of psychiatric had to wait longer than 24 hours, compared with only 0.5% of medical patients. The average length of stay was significantly longer for psychiatric patients: 194 minutes vs. 138 minutes for medical patients (P less than .01).
Additionally, psychiatric patients were more likely to be uninsured, with 22% not having insurance, compared with 15% of medical patients being uninsured. Furthermore, 4.6% of the psychiatric patients’ previous visit to the ED had been within the prior 72 hours, compared with 3.6% of medical patients. A total of 21% of psychiatric patients required admittance, compared with 13% of medical patients, while 11% of psychiatric patients were transferred, compared with just 1.4% of medical patients.
“These results compel us to further investigate the potential causes of prolonged length of stay in psychiatric patients and to further characterize the population of psychiatric patients most at risk of prolonged stays,” Dr. Lippert and her coinvestigators concluded.
ACEP President Rebecca B. Parker, MD, chimed in during the conference call, explaining that a survey of more than 1,700 emergency physicians revealed some “troubling” findings about the state of emergency departments over the last year.
The nation’s dwindling mental health resources are having a direct impact on patients having psychiatric emergencies, including children,” Dr. Parker explained. “These patients are waiting longer for care, especially those patients who require hospitalization.”
Findings of the survey indicate that 48% of ED physicians witness psychiatric patients being “boarded” in their EDs at least once a day while they wait for a bed. Additionally, less than 17% of respondents said their ED has a psychiatrist on call to respond to psychiatric emergencies, with 11.7% responding that they have no psychiatrist on call to deal with such emergencies. And 52% of respondents said the mental health system in their community has gotten noticeably worse in just the last year.
In a separate statement, Dr. Parker voiced outrage about the situation. “Psychiatric patients wait in the emergency department for hours and even days for a bed, which delays the psychiatric care they so desperately need,” she said. “It also leads to delays in care and diminished resources for other emergency patients. The emergency department has become the dumping ground for these vulnerable patients who have been abandoned by every other part of the health care system.”
ACEP presented the findings during its annual meeting in Las Vegas. No funding sources for these studies were disclosed; Dr. Lippert did not report any financial disclosures.
FROM AN ACEP TELECONFERENCE
Key clinical point:
Major finding: Higher percentages of psychiatric patients have to wait more than a day before disposition, compared with medical patients.
Data source: Two retrospective reviews of more than 65 million ED visits in the NHAMCS database from 2001-2011.
Disclosures: No funding sources or disclosures were reported.
Laparoscopy comparable to open staging for uterine papillary serous cancer
BOSTON – Laparoscopic staging of patients with uterine papillary serous carcinoma is a safe alternative to open staging and may offer some advantages, according to findings presented at the annual Minimally Invasive Surgery Week.
“Traditionally, serous papillary cancer has been treated different than the other endometrial cancers, the reason being is that it tends to behave more like ovarian cancer,” Jeanette Voice, MD, of Richmond University Medical Center in Staten Island, N.Y., said at the meeting, which was held by the Society for Laparoendoscopic Surgeons. “Patients with serous papillary cancer tend to be older [so] these patients may benefit from a less invasive surgical approach.”
Dr. Voice and her coinvestigators conducted an 8-year retrospective study of laparoscopic and open-staged cases treated from March 2007 through May 2015. Initially, 59 patients with pathology-confirmed uterine papillary serous carcinoma were identified over that time period, and were divided into two cohorts: one receiving open surgery (37 patients) and one receiving laparoscopic surgery (22 patients).
Median age, body mass index, and prior abdominal surgery rate were not significantly different between the two cohorts.
In terms of intraoperative factors, median operative times for the open and laparoscopic cohorts were similar: 196 minutes versus 216 minutes, respectively (P = .561). Similarly, the number of pelvic lymph node dissections and rate of omentectomy were also not significantly different: 18 nodes (open) versus 16 nodes (laparoscopic) (P = .96), and 100% (open) versus 91% (laparoscopic) (P = .08).
However, laparoscopic patients had more favorable median estimated blood loss (310 mL versus 175 mL, P = .048) and shorter hospital stays (4 days versus 1 day, P less than .042).
Laparoscopic patients also achieved more robust debulking to zero centimeter residual disease, with 90.5% of patients achieving it versus 65.7% of those in the open surgery cohort, but the difference was not statistically significant (P = .1).
In terms of postoperative adjuvant therapy – brachytherapy, external beam radiation, and chemotherapy – there were no significant differences in outcomes between the two cohorts. Recurrence rates were also similar, with nine recurrences in the open cohort and eight recurrences in the laparoscopic cohort. The estimated 36-month progression-free survival rates were “almost identical,” with 55.3% in the open cohort versus 53.3% in the laparoscopic (P = .727), according to Dr. Voice.
Postoperative complications were more common in the open surgery cohort (29.7%), compared with 13.6% in the laparoscopic cohort, but no statistically significant difference was found between them (P = .16).
Dr. Voice did not report information on financial disclosures.
BOSTON – Laparoscopic staging of patients with uterine papillary serous carcinoma is a safe alternative to open staging and may offer some advantages, according to findings presented at the annual Minimally Invasive Surgery Week.
“Traditionally, serous papillary cancer has been treated different than the other endometrial cancers, the reason being is that it tends to behave more like ovarian cancer,” Jeanette Voice, MD, of Richmond University Medical Center in Staten Island, N.Y., said at the meeting, which was held by the Society for Laparoendoscopic Surgeons. “Patients with serous papillary cancer tend to be older [so] these patients may benefit from a less invasive surgical approach.”
Dr. Voice and her coinvestigators conducted an 8-year retrospective study of laparoscopic and open-staged cases treated from March 2007 through May 2015. Initially, 59 patients with pathology-confirmed uterine papillary serous carcinoma were identified over that time period, and were divided into two cohorts: one receiving open surgery (37 patients) and one receiving laparoscopic surgery (22 patients).
Median age, body mass index, and prior abdominal surgery rate were not significantly different between the two cohorts.
In terms of intraoperative factors, median operative times for the open and laparoscopic cohorts were similar: 196 minutes versus 216 minutes, respectively (P = .561). Similarly, the number of pelvic lymph node dissections and rate of omentectomy were also not significantly different: 18 nodes (open) versus 16 nodes (laparoscopic) (P = .96), and 100% (open) versus 91% (laparoscopic) (P = .08).
However, laparoscopic patients had more favorable median estimated blood loss (310 mL versus 175 mL, P = .048) and shorter hospital stays (4 days versus 1 day, P less than .042).
Laparoscopic patients also achieved more robust debulking to zero centimeter residual disease, with 90.5% of patients achieving it versus 65.7% of those in the open surgery cohort, but the difference was not statistically significant (P = .1).
In terms of postoperative adjuvant therapy – brachytherapy, external beam radiation, and chemotherapy – there were no significant differences in outcomes between the two cohorts. Recurrence rates were also similar, with nine recurrences in the open cohort and eight recurrences in the laparoscopic cohort. The estimated 36-month progression-free survival rates were “almost identical,” with 55.3% in the open cohort versus 53.3% in the laparoscopic (P = .727), according to Dr. Voice.
Postoperative complications were more common in the open surgery cohort (29.7%), compared with 13.6% in the laparoscopic cohort, but no statistically significant difference was found between them (P = .16).
Dr. Voice did not report information on financial disclosures.
BOSTON – Laparoscopic staging of patients with uterine papillary serous carcinoma is a safe alternative to open staging and may offer some advantages, according to findings presented at the annual Minimally Invasive Surgery Week.
“Traditionally, serous papillary cancer has been treated different than the other endometrial cancers, the reason being is that it tends to behave more like ovarian cancer,” Jeanette Voice, MD, of Richmond University Medical Center in Staten Island, N.Y., said at the meeting, which was held by the Society for Laparoendoscopic Surgeons. “Patients with serous papillary cancer tend to be older [so] these patients may benefit from a less invasive surgical approach.”
Dr. Voice and her coinvestigators conducted an 8-year retrospective study of laparoscopic and open-staged cases treated from March 2007 through May 2015. Initially, 59 patients with pathology-confirmed uterine papillary serous carcinoma were identified over that time period, and were divided into two cohorts: one receiving open surgery (37 patients) and one receiving laparoscopic surgery (22 patients).
Median age, body mass index, and prior abdominal surgery rate were not significantly different between the two cohorts.
In terms of intraoperative factors, median operative times for the open and laparoscopic cohorts were similar: 196 minutes versus 216 minutes, respectively (P = .561). Similarly, the number of pelvic lymph node dissections and rate of omentectomy were also not significantly different: 18 nodes (open) versus 16 nodes (laparoscopic) (P = .96), and 100% (open) versus 91% (laparoscopic) (P = .08).
However, laparoscopic patients had more favorable median estimated blood loss (310 mL versus 175 mL, P = .048) and shorter hospital stays (4 days versus 1 day, P less than .042).
Laparoscopic patients also achieved more robust debulking to zero centimeter residual disease, with 90.5% of patients achieving it versus 65.7% of those in the open surgery cohort, but the difference was not statistically significant (P = .1).
In terms of postoperative adjuvant therapy – brachytherapy, external beam radiation, and chemotherapy – there were no significant differences in outcomes between the two cohorts. Recurrence rates were also similar, with nine recurrences in the open cohort and eight recurrences in the laparoscopic cohort. The estimated 36-month progression-free survival rates were “almost identical,” with 55.3% in the open cohort versus 53.3% in the laparoscopic (P = .727), according to Dr. Voice.
Postoperative complications were more common in the open surgery cohort (29.7%), compared with 13.6% in the laparoscopic cohort, but no statistically significant difference was found between them (P = .16).
Dr. Voice did not report information on financial disclosures.
AT MINIMALLY INVASIVE SURGERY WEEK
Key clinical point:
Major finding: Laparoscopic patients had lower median estimated blood loss (310 mL v. 175 mL, P = .048) and shorter hospital stays (4 days v. 1 day, P less than .042).
Data source: Retrospective review of data on 59 open and laparoscopic patients over 8 years.
Disclosures: Dr. Voice did not report information on financial disclosures.
Underlay mesh for hernia repair yields better postop pain outcomes
Chronic pain that typically follows primary inguinal hernia repair can be significantly reduced by adopting procedures that use underlay mesh rather than overlay mesh, according to a new study published in the Journal of Surgical Research.
“Although chronic pain and discomfort is still one of the greatest problems after inguinal hernia repair due to the fact that it interferes with patients’ quality of life, there are very little data available from previous studies concerning presentation, diagnosis, and modes of treatment of this issue. In particular, the data in the literature concerning the cause of chronic pain are very limited,” wrote the authors, led by Hideyuki Takata, MD, of Nippon Medical School, Tokyo.
Dr. Takata and his coinvestigators looked at patients who underwent a mesh repair operation for primary inguinal hernia at a single institution – Nippon Medical School – between May 2011 and May 2014. All patients were aged 40 years or older, and the overwhelming majority were male. A total of 334 patients were identified, with 378 lesions among them; all patients’ operations were performed via the Lichtenstein (onlay mesh only), Ultrapro Plug (onlay and plug mesh), modified Kugel Patch (onlay and underlay mesh), or laparoscopic transabdominal preperitoneal (underlay mesh only, TAPP) surgical routes.
Forty-four patients had bilateral lesions, 152 had lesions on the right, and 138 on the left; 76 patients received Lichtenstein operations, 85 received Ultrapro Plug, 156 received modified Kugel Patch, and 61 received TAPP. (J Surg Res 2016 Aug 11. doi: 10.1016/j.jss.2016.08.027).
Patients received questionnaires at 2-3 weeks, 3 months, and 6 months after the operation to determine their pain and discomfort levels. Responses for all 378 lesions (100%) were received at the first follow-up, with questionnaires received for 229 lesions (60.5%) at the 3-month follow-up and 249 lesions (65.9%) at the 6-month follow-up. Of those who responded at the 6-month follow-up, 46 received Lichtenstein, 59 received Ultrapro Plug, 101 received modified Kugel Patch, and 61 received TAPP.
No patients reported moderate or severe pain while at rest. Mild pain was reported by 11 (4.4%) of all respondents; 0 of those who received Lichtenstein, 4 (6.8%) of those who received Ultrapro Plug, 7 (6.9%) of those who received modified Kugel Patch, and 0 of those who received TAPP (P less than .01).
Pain with movement was reported in 35 (14.1%) of respondents: 6 (13.0%) of those who received Lichtenstein, 7 (11.9%) of those who received Ultrapro Plug, 20 (19.8%) of those who received modified Kugel Patch, and 2 (4.7%) of those who received TAPP (P less than .05). One respondent reported experiencing moderate pain with movement, and that individual received Ultrapro Plug (1.7%). No patients reported experiencing severe pain with movement.
“We conclude that the sensory nerves in the inguinal region should be kept away from the mesh to prevent the development of chronic pain and discomfort,” the investigators concluded. “Further study is required to determine the mechanism involved in the generation of chronic pain and discomfort to improve the patient’s quality of life after primary inguinal hernia repair.”
No funding source was disclosed for this study. Dr. Takata and his coauthors did not report any relevant financial disclosures.
Chronic pain that typically follows primary inguinal hernia repair can be significantly reduced by adopting procedures that use underlay mesh rather than overlay mesh, according to a new study published in the Journal of Surgical Research.
“Although chronic pain and discomfort is still one of the greatest problems after inguinal hernia repair due to the fact that it interferes with patients’ quality of life, there are very little data available from previous studies concerning presentation, diagnosis, and modes of treatment of this issue. In particular, the data in the literature concerning the cause of chronic pain are very limited,” wrote the authors, led by Hideyuki Takata, MD, of Nippon Medical School, Tokyo.
Dr. Takata and his coinvestigators looked at patients who underwent a mesh repair operation for primary inguinal hernia at a single institution – Nippon Medical School – between May 2011 and May 2014. All patients were aged 40 years or older, and the overwhelming majority were male. A total of 334 patients were identified, with 378 lesions among them; all patients’ operations were performed via the Lichtenstein (onlay mesh only), Ultrapro Plug (onlay and plug mesh), modified Kugel Patch (onlay and underlay mesh), or laparoscopic transabdominal preperitoneal (underlay mesh only, TAPP) surgical routes.
Forty-four patients had bilateral lesions, 152 had lesions on the right, and 138 on the left; 76 patients received Lichtenstein operations, 85 received Ultrapro Plug, 156 received modified Kugel Patch, and 61 received TAPP. (J Surg Res 2016 Aug 11. doi: 10.1016/j.jss.2016.08.027).
Patients received questionnaires at 2-3 weeks, 3 months, and 6 months after the operation to determine their pain and discomfort levels. Responses for all 378 lesions (100%) were received at the first follow-up, with questionnaires received for 229 lesions (60.5%) at the 3-month follow-up and 249 lesions (65.9%) at the 6-month follow-up. Of those who responded at the 6-month follow-up, 46 received Lichtenstein, 59 received Ultrapro Plug, 101 received modified Kugel Patch, and 61 received TAPP.
No patients reported moderate or severe pain while at rest. Mild pain was reported by 11 (4.4%) of all respondents; 0 of those who received Lichtenstein, 4 (6.8%) of those who received Ultrapro Plug, 7 (6.9%) of those who received modified Kugel Patch, and 0 of those who received TAPP (P less than .01).
Pain with movement was reported in 35 (14.1%) of respondents: 6 (13.0%) of those who received Lichtenstein, 7 (11.9%) of those who received Ultrapro Plug, 20 (19.8%) of those who received modified Kugel Patch, and 2 (4.7%) of those who received TAPP (P less than .05). One respondent reported experiencing moderate pain with movement, and that individual received Ultrapro Plug (1.7%). No patients reported experiencing severe pain with movement.
“We conclude that the sensory nerves in the inguinal region should be kept away from the mesh to prevent the development of chronic pain and discomfort,” the investigators concluded. “Further study is required to determine the mechanism involved in the generation of chronic pain and discomfort to improve the patient’s quality of life after primary inguinal hernia repair.”
No funding source was disclosed for this study. Dr. Takata and his coauthors did not report any relevant financial disclosures.
Chronic pain that typically follows primary inguinal hernia repair can be significantly reduced by adopting procedures that use underlay mesh rather than overlay mesh, according to a new study published in the Journal of Surgical Research.
“Although chronic pain and discomfort is still one of the greatest problems after inguinal hernia repair due to the fact that it interferes with patients’ quality of life, there are very little data available from previous studies concerning presentation, diagnosis, and modes of treatment of this issue. In particular, the data in the literature concerning the cause of chronic pain are very limited,” wrote the authors, led by Hideyuki Takata, MD, of Nippon Medical School, Tokyo.
Dr. Takata and his coinvestigators looked at patients who underwent a mesh repair operation for primary inguinal hernia at a single institution – Nippon Medical School – between May 2011 and May 2014. All patients were aged 40 years or older, and the overwhelming majority were male. A total of 334 patients were identified, with 378 lesions among them; all patients’ operations were performed via the Lichtenstein (onlay mesh only), Ultrapro Plug (onlay and plug mesh), modified Kugel Patch (onlay and underlay mesh), or laparoscopic transabdominal preperitoneal (underlay mesh only, TAPP) surgical routes.
Forty-four patients had bilateral lesions, 152 had lesions on the right, and 138 on the left; 76 patients received Lichtenstein operations, 85 received Ultrapro Plug, 156 received modified Kugel Patch, and 61 received TAPP. (J Surg Res 2016 Aug 11. doi: 10.1016/j.jss.2016.08.027).
Patients received questionnaires at 2-3 weeks, 3 months, and 6 months after the operation to determine their pain and discomfort levels. Responses for all 378 lesions (100%) were received at the first follow-up, with questionnaires received for 229 lesions (60.5%) at the 3-month follow-up and 249 lesions (65.9%) at the 6-month follow-up. Of those who responded at the 6-month follow-up, 46 received Lichtenstein, 59 received Ultrapro Plug, 101 received modified Kugel Patch, and 61 received TAPP.
No patients reported moderate or severe pain while at rest. Mild pain was reported by 11 (4.4%) of all respondents; 0 of those who received Lichtenstein, 4 (6.8%) of those who received Ultrapro Plug, 7 (6.9%) of those who received modified Kugel Patch, and 0 of those who received TAPP (P less than .01).
Pain with movement was reported in 35 (14.1%) of respondents: 6 (13.0%) of those who received Lichtenstein, 7 (11.9%) of those who received Ultrapro Plug, 20 (19.8%) of those who received modified Kugel Patch, and 2 (4.7%) of those who received TAPP (P less than .05). One respondent reported experiencing moderate pain with movement, and that individual received Ultrapro Plug (1.7%). No patients reported experiencing severe pain with movement.
“We conclude that the sensory nerves in the inguinal region should be kept away from the mesh to prevent the development of chronic pain and discomfort,” the investigators concluded. “Further study is required to determine the mechanism involved in the generation of chronic pain and discomfort to improve the patient’s quality of life after primary inguinal hernia repair.”
No funding source was disclosed for this study. Dr. Takata and his coauthors did not report any relevant financial disclosures.
Key clinical point:
Major finding: Mild pain at rest and with movement were both significantly lower in patients who received TAPP than in those who received one of three other surgical procedures.
Data source: Retrospective analysis of 334 primary inguinal hernia patients with 378 lesions undergoing TAPP or Lichtenstein procedures.
Disclosures: The authors did not report any relevant financial disclosures.
HIV PrEP facing challenges, but implementation outlook positive
ATLANTA – Implementation of HIV preexposure prophylaxis (PrEP) by local health departments in the United States faces several challenges, but the majority of those already engaged plan to increase their participation soon, a study showed.
“For the purposes of this study, we very broadly defined engagement in PrEP implementation as anything from participating in a local or statewide working group, to planning and supporting implementation of PrEP, to doing community education and outreach, or working with providers to deliver PrEP via health department clinics,” explained Gretchen Weiss, director of HIV, STI, and viral hepatitis at the National Association of County and City Health Officials in Washington, D.C.
A total of 53% of LHDs now engaged in PrEP implementation anticipate expanding their engagement soon, 39% responded that they were unsure about expanding, and 8% said that they did not plan to expand PrEP engagement. Of the LHDs not currently implementing PrEP, 18% reported that they plan to implement PrEP within the next 4 years, while 46% were undecided, and 36% said they had no plans to implement PrEP, Ms. Weiss reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
Of the 109 LHDs using HIV PrEP, 75% reported that they are referring individuals at high risk for sexually transmitted diseases to PrEP, while 50% said that they conduct community outreach and education regarding the benefits of using PrEP. When asked what they viewed as their “optimal role” with regard to PrEP, 77% said that it was referring high-risk individuals for treatment. Sixty-five percent reported that their optimal role was to identify PrEP providers and develop referral lists, while 33% thought that delivering PrEP via health department clinics was the optimal role for their engagement in PrEP.
“In terms of the challenges faced by LHDs, 64% reported limited staff capacity, 57% reported concerns about financial access to PrEP, and 47% responded not having enough providers that are willing to provide PrEP,” Ms. Weiss said. “Thirteen percent reported that they didn’t face any significant challenges.”
No funding source for this study was disclosed. Ms. Weiss did not report any relevant financial disclosures.
ATLANTA – Implementation of HIV preexposure prophylaxis (PrEP) by local health departments in the United States faces several challenges, but the majority of those already engaged plan to increase their participation soon, a study showed.
“For the purposes of this study, we very broadly defined engagement in PrEP implementation as anything from participating in a local or statewide working group, to planning and supporting implementation of PrEP, to doing community education and outreach, or working with providers to deliver PrEP via health department clinics,” explained Gretchen Weiss, director of HIV, STI, and viral hepatitis at the National Association of County and City Health Officials in Washington, D.C.
A total of 53% of LHDs now engaged in PrEP implementation anticipate expanding their engagement soon, 39% responded that they were unsure about expanding, and 8% said that they did not plan to expand PrEP engagement. Of the LHDs not currently implementing PrEP, 18% reported that they plan to implement PrEP within the next 4 years, while 46% were undecided, and 36% said they had no plans to implement PrEP, Ms. Weiss reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
Of the 109 LHDs using HIV PrEP, 75% reported that they are referring individuals at high risk for sexually transmitted diseases to PrEP, while 50% said that they conduct community outreach and education regarding the benefits of using PrEP. When asked what they viewed as their “optimal role” with regard to PrEP, 77% said that it was referring high-risk individuals for treatment. Sixty-five percent reported that their optimal role was to identify PrEP providers and develop referral lists, while 33% thought that delivering PrEP via health department clinics was the optimal role for their engagement in PrEP.
“In terms of the challenges faced by LHDs, 64% reported limited staff capacity, 57% reported concerns about financial access to PrEP, and 47% responded not having enough providers that are willing to provide PrEP,” Ms. Weiss said. “Thirteen percent reported that they didn’t face any significant challenges.”
No funding source for this study was disclosed. Ms. Weiss did not report any relevant financial disclosures.
ATLANTA – Implementation of HIV preexposure prophylaxis (PrEP) by local health departments in the United States faces several challenges, but the majority of those already engaged plan to increase their participation soon, a study showed.
“For the purposes of this study, we very broadly defined engagement in PrEP implementation as anything from participating in a local or statewide working group, to planning and supporting implementation of PrEP, to doing community education and outreach, or working with providers to deliver PrEP via health department clinics,” explained Gretchen Weiss, director of HIV, STI, and viral hepatitis at the National Association of County and City Health Officials in Washington, D.C.
A total of 53% of LHDs now engaged in PrEP implementation anticipate expanding their engagement soon, 39% responded that they were unsure about expanding, and 8% said that they did not plan to expand PrEP engagement. Of the LHDs not currently implementing PrEP, 18% reported that they plan to implement PrEP within the next 4 years, while 46% were undecided, and 36% said they had no plans to implement PrEP, Ms. Weiss reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
Of the 109 LHDs using HIV PrEP, 75% reported that they are referring individuals at high risk for sexually transmitted diseases to PrEP, while 50% said that they conduct community outreach and education regarding the benefits of using PrEP. When asked what they viewed as their “optimal role” with regard to PrEP, 77% said that it was referring high-risk individuals for treatment. Sixty-five percent reported that their optimal role was to identify PrEP providers and develop referral lists, while 33% thought that delivering PrEP via health department clinics was the optimal role for their engagement in PrEP.
“In terms of the challenges faced by LHDs, 64% reported limited staff capacity, 57% reported concerns about financial access to PrEP, and 47% responded not having enough providers that are willing to provide PrEP,” Ms. Weiss said. “Thirteen percent reported that they didn’t face any significant challenges.”
No funding source for this study was disclosed. Ms. Weiss did not report any relevant financial disclosures.
Key clinical point:
Major finding: 53% of LHDs engaged in PrEP plan to increase participation; 18% of LHDs not currently engaged in PrEP plan to implement within the next 4 years.
Data source: A survey of 284 local health departments from across the United States.
Disclosures: Ms. Weiss did not report any relevant financial conflicts.
Laparoscopic sacrocolpopexy offers advantages over abdominal route
BOSTON – Laparoscopic sacrocolpopexy offers some distinct advantages over the abdominal route for treatment of pelvic organ prolapse, including reduced intraoperative blood loss and shorter hospital stays, according to findings from a new research review.
“We wanted to compare the efficiency and safety of abdominal sacral colpopexy and laparoscopic sacral colpopexy for the treatment of pelvic organ collapse,” Juan Liu, MD, of Guangzhou Medical University in China said at the annual Minimally Invasive Surgery Week, held by the Society of Laparoendoscopic Surgeons.
Analyses directly comparing the safety and effectiveness of the two surgical routes are low in number, Dr. Liu added.
The researchers looked at published articles, written in English or Chinese, that were either retrospective analyses or randomized controlled trial studies examining laparoscopic sacrocolpopexy (LSC) or abdominal sacrocolpopexy (ASC), with follow-up times of at least 30 days.
Studies that investigated robot-assisted sacrocolpopexy were excluded, as well as studies for which there were no specific feature data or for which the full text of the study was inaccessible. Of 1,807 articles identified, 10 studies containing 3,816 cases were included for the analysis.
The studies were used to compare laparoscopic and abdominal sacrocolpopexy on the following criteria: operating time; blood loss; hospital length of stay; intraoperative complications such as urinary, bladder, and rectal injury; and postoperative complications such as infection, intestinal obstruction, mesh exposure, new urinary incontinence, and dyspareunia. Weighted mean difference was calculated to account for the different sample sizes across the studies.
The weighted mean difference in intraoperative blood loss in the laparoscopic cohort, compared with the abdominal cohort, was –100.68 mL (P less than .01). Hospital length of stay was also significantly reduced in the laparoscopic cohort, with a weighted mean difference of –1.77 days (P less than .01). The odds ratio for gastrointestinal complications was 0.30 for the laparoscopic route, compared with the abdominal route (P less than .01).
Additionally, pulmonary complications and blood transfusions were also found to be reduced with laparoscopic sacrocolpopexy, compared with abdominal sacrocolpopexy, with an odds ratio of 0.59 (P = .02) and 0.47 (P = .03), respectively.
But the review found little difference in other areas. The weighted mean difference for operating time in the laparoscopic cohort was 0.06 minutes, compared with the abdominal cohort, which was not statistically significant (P= .84). And there was not a statistically significant difference between the two surgical approaches in urinary complications (OR, 0.41; P = .11), cardiovascular complications (OR, 0.31; P = .49), or mesh exposure (OR, 1.60, P = .18).
No funding source for this study was disclosed. Dr. Liu reported having no relevant financial disclosures.
BOSTON – Laparoscopic sacrocolpopexy offers some distinct advantages over the abdominal route for treatment of pelvic organ prolapse, including reduced intraoperative blood loss and shorter hospital stays, according to findings from a new research review.
“We wanted to compare the efficiency and safety of abdominal sacral colpopexy and laparoscopic sacral colpopexy for the treatment of pelvic organ collapse,” Juan Liu, MD, of Guangzhou Medical University in China said at the annual Minimally Invasive Surgery Week, held by the Society of Laparoendoscopic Surgeons.
Analyses directly comparing the safety and effectiveness of the two surgical routes are low in number, Dr. Liu added.
The researchers looked at published articles, written in English or Chinese, that were either retrospective analyses or randomized controlled trial studies examining laparoscopic sacrocolpopexy (LSC) or abdominal sacrocolpopexy (ASC), with follow-up times of at least 30 days.
Studies that investigated robot-assisted sacrocolpopexy were excluded, as well as studies for which there were no specific feature data or for which the full text of the study was inaccessible. Of 1,807 articles identified, 10 studies containing 3,816 cases were included for the analysis.
The studies were used to compare laparoscopic and abdominal sacrocolpopexy on the following criteria: operating time; blood loss; hospital length of stay; intraoperative complications such as urinary, bladder, and rectal injury; and postoperative complications such as infection, intestinal obstruction, mesh exposure, new urinary incontinence, and dyspareunia. Weighted mean difference was calculated to account for the different sample sizes across the studies.
The weighted mean difference in intraoperative blood loss in the laparoscopic cohort, compared with the abdominal cohort, was –100.68 mL (P less than .01). Hospital length of stay was also significantly reduced in the laparoscopic cohort, with a weighted mean difference of –1.77 days (P less than .01). The odds ratio for gastrointestinal complications was 0.30 for the laparoscopic route, compared with the abdominal route (P less than .01).
Additionally, pulmonary complications and blood transfusions were also found to be reduced with laparoscopic sacrocolpopexy, compared with abdominal sacrocolpopexy, with an odds ratio of 0.59 (P = .02) and 0.47 (P = .03), respectively.
But the review found little difference in other areas. The weighted mean difference for operating time in the laparoscopic cohort was 0.06 minutes, compared with the abdominal cohort, which was not statistically significant (P= .84). And there was not a statistically significant difference between the two surgical approaches in urinary complications (OR, 0.41; P = .11), cardiovascular complications (OR, 0.31; P = .49), or mesh exposure (OR, 1.60, P = .18).
No funding source for this study was disclosed. Dr. Liu reported having no relevant financial disclosures.
BOSTON – Laparoscopic sacrocolpopexy offers some distinct advantages over the abdominal route for treatment of pelvic organ prolapse, including reduced intraoperative blood loss and shorter hospital stays, according to findings from a new research review.
“We wanted to compare the efficiency and safety of abdominal sacral colpopexy and laparoscopic sacral colpopexy for the treatment of pelvic organ collapse,” Juan Liu, MD, of Guangzhou Medical University in China said at the annual Minimally Invasive Surgery Week, held by the Society of Laparoendoscopic Surgeons.
Analyses directly comparing the safety and effectiveness of the two surgical routes are low in number, Dr. Liu added.
The researchers looked at published articles, written in English or Chinese, that were either retrospective analyses or randomized controlled trial studies examining laparoscopic sacrocolpopexy (LSC) or abdominal sacrocolpopexy (ASC), with follow-up times of at least 30 days.
Studies that investigated robot-assisted sacrocolpopexy were excluded, as well as studies for which there were no specific feature data or for which the full text of the study was inaccessible. Of 1,807 articles identified, 10 studies containing 3,816 cases were included for the analysis.
The studies were used to compare laparoscopic and abdominal sacrocolpopexy on the following criteria: operating time; blood loss; hospital length of stay; intraoperative complications such as urinary, bladder, and rectal injury; and postoperative complications such as infection, intestinal obstruction, mesh exposure, new urinary incontinence, and dyspareunia. Weighted mean difference was calculated to account for the different sample sizes across the studies.
The weighted mean difference in intraoperative blood loss in the laparoscopic cohort, compared with the abdominal cohort, was –100.68 mL (P less than .01). Hospital length of stay was also significantly reduced in the laparoscopic cohort, with a weighted mean difference of –1.77 days (P less than .01). The odds ratio for gastrointestinal complications was 0.30 for the laparoscopic route, compared with the abdominal route (P less than .01).
Additionally, pulmonary complications and blood transfusions were also found to be reduced with laparoscopic sacrocolpopexy, compared with abdominal sacrocolpopexy, with an odds ratio of 0.59 (P = .02) and 0.47 (P = .03), respectively.
But the review found little difference in other areas. The weighted mean difference for operating time in the laparoscopic cohort was 0.06 minutes, compared with the abdominal cohort, which was not statistically significant (P= .84). And there was not a statistically significant difference between the two surgical approaches in urinary complications (OR, 0.41; P = .11), cardiovascular complications (OR, 0.31; P = .49), or mesh exposure (OR, 1.60, P = .18).
No funding source for this study was disclosed. Dr. Liu reported having no relevant financial disclosures.
AT MINIMALLY INVASIVE SURGERY WEEK
Key clinical point:
Major finding: The weighted mean difference in intraoperative blood loss in the laparoscopic cohort, compared with the abdominal cohort, was –100.68 mL (P less than .01).
Data source: Retrospective review of 10 studies involving 3,816 sacrocolpopexy cases.
Disclosures: Dr. Liu reported having no relevant financial disclosures.
Further evidence links Zika, Guillain-Barré syndrome
Evidence of Zika virus found in Colombian patients with Guillain-Barré syndrome supports the theory that Zika virus infection and Guillain-Barré syndrome are related and could occur parainfectiously, according to a study published in the New England Journal of Medicine.
“Our study provides virologic evidence of [Zika virus] infection in patients with Guillain-Barré syndrome,” wrote Beatriz Parra, PhD, of the Hospital Universitario del Valle in Valle del Cauca, Colombia, and her coauthors (N Engl J Med. 2016 Oct 5. doi: 10.1056/NEJMoa1605564).
Results indicated that 66 (97%) of subjects had symptoms consistent with a Zika virus infection prior to the onset of Guillain-Barré syndrome. The median number of days between onset of Zika-like symptoms and the onset of Guillain-Barré syndrome was found to be 7 days (interquartile range, 3-10 days). Seventeen (40%) of the 42 patients who underwent laboratory testing tested positive for Zika virus RNA in their sample, with 16 of those 17 positive tests coming from urine samples. Additionally, 18 of the 42 laboratory-tested subjects had “clinical and immunologic findings [that] supported” a Zika virus infection.
“The onset of the Guillain-Barré syndrome can parallel the onset of systemic manifestations of [Zika virus] infection, indicating a so-called parainfectious onset, which suggests that factors different from the known postinfectious mechanisms may be present in [Zika virus]–related Guillain-Barré syndrome,” the authors explained, adding that 20 (48%) of the 42 laboratory-tested subjects had a parainfectious onset.
“RT-PCR testing of urine is a valuable diagnostic tool for the identification of [Zika virus] infection in patients with Guillain-Barré syndrome,” Dr. Parra and her coauthors concluded.
The study was funded by the Bart McLean Fund for Neuroimmunology Research, Johns Hopkins Project Restore, and the Universidad del Valle. Dr. Parra reported no relevant financial disclosures.
Dr. Parra and her colleagues report in the Journal the results of a prospective study of 68 Colombian patients who had a syndrome consistent with the Guillain-Barré syndrome, 66 of whom had previously had symptoms of Zika virus (ZIKV) infection. Major strengths of this study include the documentation of a temporal relationship between the Guillain-Barré syndrome and ZIKV infection (marked by a substantial increase in the incidence of the Guillain-Barré syndrome after the introduction of ZIKV, from 20 to 90 cases per month throughout Colombia), the criteria applied for the diagnosis of the Guillain-Barré syndrome, and the molecular and serologic flavivirus data from analyses of serum, cerebrospinal fluid, and urine.
The difficulties in diagnosing ZIKV infection are borne out in this study, as only 17 patients had definitive laboratory evidence of recent ZIKV infection. Of these 17 patients, only 14 had electrophysiologic data consistent with the Guillain-Barré syndrome and therefore could have met Brighton level 1 diagnostic criteria for the syndrome. Among the 25 ZIKV PCR–negative patients, dengue virus (DENV) IgG antibodies were present in the cerebrospinal fluid of 12 patients and in the serum of 10 patients, and serum DENV IgM test results were positive in 1. These data raise the possibility of primary DENV infection and false-positive ZIKV serologic test results from cross reactivity.
Overall, the study by Dr. Parra and her colleagues supports the association between ZIKV and the Guillain-Barré syndrome, although confirmation in another cohort would strengthen this assertion. Although high rates of seropositivity may prove protective against further waves of ZIKV-related Guillain-Barré syndrome in Central and South America, the ZIKV pandemic is just beginning in North America and Africa, and an increase in the incidence of the Guillain-Barré syndrome may follow.
Jennifer A. Frontera, MD, is with the Cerebrovascular Center at the Cleveland Clinic in Cleveland. Ivan R.F. da Silva. MD, is with the Federal Fluminense University in Niterói, Brazil. These comments were adapted from their editorial accompanying the study ( N Engl J Med. 2016 Oct 5. doi: 10.1056/NEJMe1611840 ).
Dr. Parra and her colleagues report in the Journal the results of a prospective study of 68 Colombian patients who had a syndrome consistent with the Guillain-Barré syndrome, 66 of whom had previously had symptoms of Zika virus (ZIKV) infection. Major strengths of this study include the documentation of a temporal relationship between the Guillain-Barré syndrome and ZIKV infection (marked by a substantial increase in the incidence of the Guillain-Barré syndrome after the introduction of ZIKV, from 20 to 90 cases per month throughout Colombia), the criteria applied for the diagnosis of the Guillain-Barré syndrome, and the molecular and serologic flavivirus data from analyses of serum, cerebrospinal fluid, and urine.
The difficulties in diagnosing ZIKV infection are borne out in this study, as only 17 patients had definitive laboratory evidence of recent ZIKV infection. Of these 17 patients, only 14 had electrophysiologic data consistent with the Guillain-Barré syndrome and therefore could have met Brighton level 1 diagnostic criteria for the syndrome. Among the 25 ZIKV PCR–negative patients, dengue virus (DENV) IgG antibodies were present in the cerebrospinal fluid of 12 patients and in the serum of 10 patients, and serum DENV IgM test results were positive in 1. These data raise the possibility of primary DENV infection and false-positive ZIKV serologic test results from cross reactivity.
Overall, the study by Dr. Parra and her colleagues supports the association between ZIKV and the Guillain-Barré syndrome, although confirmation in another cohort would strengthen this assertion. Although high rates of seropositivity may prove protective against further waves of ZIKV-related Guillain-Barré syndrome in Central and South America, the ZIKV pandemic is just beginning in North America and Africa, and an increase in the incidence of the Guillain-Barré syndrome may follow.
Jennifer A. Frontera, MD, is with the Cerebrovascular Center at the Cleveland Clinic in Cleveland. Ivan R.F. da Silva. MD, is with the Federal Fluminense University in Niterói, Brazil. These comments were adapted from their editorial accompanying the study ( N Engl J Med. 2016 Oct 5. doi: 10.1056/NEJMe1611840 ).
Dr. Parra and her colleagues report in the Journal the results of a prospective study of 68 Colombian patients who had a syndrome consistent with the Guillain-Barré syndrome, 66 of whom had previously had symptoms of Zika virus (ZIKV) infection. Major strengths of this study include the documentation of a temporal relationship between the Guillain-Barré syndrome and ZIKV infection (marked by a substantial increase in the incidence of the Guillain-Barré syndrome after the introduction of ZIKV, from 20 to 90 cases per month throughout Colombia), the criteria applied for the diagnosis of the Guillain-Barré syndrome, and the molecular and serologic flavivirus data from analyses of serum, cerebrospinal fluid, and urine.
The difficulties in diagnosing ZIKV infection are borne out in this study, as only 17 patients had definitive laboratory evidence of recent ZIKV infection. Of these 17 patients, only 14 had electrophysiologic data consistent with the Guillain-Barré syndrome and therefore could have met Brighton level 1 diagnostic criteria for the syndrome. Among the 25 ZIKV PCR–negative patients, dengue virus (DENV) IgG antibodies were present in the cerebrospinal fluid of 12 patients and in the serum of 10 patients, and serum DENV IgM test results were positive in 1. These data raise the possibility of primary DENV infection and false-positive ZIKV serologic test results from cross reactivity.
Overall, the study by Dr. Parra and her colleagues supports the association between ZIKV and the Guillain-Barré syndrome, although confirmation in another cohort would strengthen this assertion. Although high rates of seropositivity may prove protective against further waves of ZIKV-related Guillain-Barré syndrome in Central and South America, the ZIKV pandemic is just beginning in North America and Africa, and an increase in the incidence of the Guillain-Barré syndrome may follow.
Jennifer A. Frontera, MD, is with the Cerebrovascular Center at the Cleveland Clinic in Cleveland. Ivan R.F. da Silva. MD, is with the Federal Fluminense University in Niterói, Brazil. These comments were adapted from their editorial accompanying the study ( N Engl J Med. 2016 Oct 5. doi: 10.1056/NEJMe1611840 ).
Evidence of Zika virus found in Colombian patients with Guillain-Barré syndrome supports the theory that Zika virus infection and Guillain-Barré syndrome are related and could occur parainfectiously, according to a study published in the New England Journal of Medicine.
“Our study provides virologic evidence of [Zika virus] infection in patients with Guillain-Barré syndrome,” wrote Beatriz Parra, PhD, of the Hospital Universitario del Valle in Valle del Cauca, Colombia, and her coauthors (N Engl J Med. 2016 Oct 5. doi: 10.1056/NEJMoa1605564).
Results indicated that 66 (97%) of subjects had symptoms consistent with a Zika virus infection prior to the onset of Guillain-Barré syndrome. The median number of days between onset of Zika-like symptoms and the onset of Guillain-Barré syndrome was found to be 7 days (interquartile range, 3-10 days). Seventeen (40%) of the 42 patients who underwent laboratory testing tested positive for Zika virus RNA in their sample, with 16 of those 17 positive tests coming from urine samples. Additionally, 18 of the 42 laboratory-tested subjects had “clinical and immunologic findings [that] supported” a Zika virus infection.
“The onset of the Guillain-Barré syndrome can parallel the onset of systemic manifestations of [Zika virus] infection, indicating a so-called parainfectious onset, which suggests that factors different from the known postinfectious mechanisms may be present in [Zika virus]–related Guillain-Barré syndrome,” the authors explained, adding that 20 (48%) of the 42 laboratory-tested subjects had a parainfectious onset.
“RT-PCR testing of urine is a valuable diagnostic tool for the identification of [Zika virus] infection in patients with Guillain-Barré syndrome,” Dr. Parra and her coauthors concluded.
The study was funded by the Bart McLean Fund for Neuroimmunology Research, Johns Hopkins Project Restore, and the Universidad del Valle. Dr. Parra reported no relevant financial disclosures.
Evidence of Zika virus found in Colombian patients with Guillain-Barré syndrome supports the theory that Zika virus infection and Guillain-Barré syndrome are related and could occur parainfectiously, according to a study published in the New England Journal of Medicine.
“Our study provides virologic evidence of [Zika virus] infection in patients with Guillain-Barré syndrome,” wrote Beatriz Parra, PhD, of the Hospital Universitario del Valle in Valle del Cauca, Colombia, and her coauthors (N Engl J Med. 2016 Oct 5. doi: 10.1056/NEJMoa1605564).
Results indicated that 66 (97%) of subjects had symptoms consistent with a Zika virus infection prior to the onset of Guillain-Barré syndrome. The median number of days between onset of Zika-like symptoms and the onset of Guillain-Barré syndrome was found to be 7 days (interquartile range, 3-10 days). Seventeen (40%) of the 42 patients who underwent laboratory testing tested positive for Zika virus RNA in their sample, with 16 of those 17 positive tests coming from urine samples. Additionally, 18 of the 42 laboratory-tested subjects had “clinical and immunologic findings [that] supported” a Zika virus infection.
“The onset of the Guillain-Barré syndrome can parallel the onset of systemic manifestations of [Zika virus] infection, indicating a so-called parainfectious onset, which suggests that factors different from the known postinfectious mechanisms may be present in [Zika virus]–related Guillain-Barré syndrome,” the authors explained, adding that 20 (48%) of the 42 laboratory-tested subjects had a parainfectious onset.
“RT-PCR testing of urine is a valuable diagnostic tool for the identification of [Zika virus] infection in patients with Guillain-Barré syndrome,” Dr. Parra and her coauthors concluded.
The study was funded by the Bart McLean Fund for Neuroimmunology Research, Johns Hopkins Project Restore, and the Universidad del Valle. Dr. Parra reported no relevant financial disclosures.
Key clinical point:
Major finding: 97% of subjects had Zika-like symptoms prior to onset of GBS, and 40% of GBS patients who underwent RT-PCR testing were positive for Zika virus.
Data source: Study of 68 GBS patients from six hospitals in Colombia, with 42 patients undergoing RT-PCR analysis.
Disclosures: Funding provided by the Bart McLean Fund for Neuroimmunology Research, Johns Hopkins Project Restore, and the Universidad del Valle. Dr. Parra reported no relevant financial disclosures.
Laparoscopic hysterectomy best in morbidly obese uterine cancer patients
BOSTON – Total laparoscopic hysterectomy had fewer complications and a shorter length of stay among morbidly obese women with uterine cancer, compared with an abdominal approach, according to findings presented at the annual Minimally Invasive Surgery Week.
“We wanted to look at current trends and see if we’re doing more the abdominal route or adopting more minimally invasive surgery, but also find out what obesity has to do with it,” Emad Mikhail, MD, of the University of South Florida in Tampa, said in an interview. “Morbidly obese patients are a really vulnerable group of patients; they have a lot of medical comorbidities, and when they need surgery they have an increased risk of having poor perioperative outcomes because of their BMI [body mass index].”
More than half of the cases were total laparoscopic hysterectomy (1,025), a third were total abdominal hysterectomy (672), about 12% were laparoscopic assisted vaginal hysterectomy (248), and less than 3% were total vaginal hysterectomy (57).
Comparing total abdominal and total laparoscopic hysterectomy – the two most commonly performed type of hysterectomy in the study – median operative times were notably higher in total laparoscopic hysterectomy: 171 minutes versus 150 minutes (P less than .05). But the laparoscopic approach had a shorter length of stay, a lower rate of hospital readmissions, and fewer surgical complications.
Within the total laparoscopic hysterectomy cohort, length of stay averaged 1 day. Dr. Mikhail reported that this cohort also had 14 blood transfusions, 13 superficial surgical site infections, 5 deep incisional surgical site infections, and 41 readmissions within 30 days, all of which were significantly lower than in the total abdominal hysterectomy cohort (P less than .05).
Mean BMI was similar in the two groups, with 34.0 in the total abdominal hysterectomy cohort and 33.7 in the total laparoscopic hysterectomy cohort.
“As the BMI goes up, more [minimally invasive surgery] is adopted, which is a great finding,” Dr. Mikhail said. “It actually serves the purpose of vulnerable patients. Instead of having an increase in perioperative morbidity, they should benefit more from a [minimally invasive surgery] approach, which this study is showing.”
Next, Dr. Mikhail said he wants to tease out what types of procedures subspecialists are performing among morbidly obese patients with uterine cancer. This type of data collection would be easier, he added, if minimally invasive gynecologic surgeons had their own taxonomy code.
“Without a code, we cannot pull data and see if being a fellowship-trained, minimally invasive surgeon has a benefit for patients,” he said. “Are those surgeons offering more minimally invasive techniques for morbidly obese patients?”
Dr. Mikhail reported having no relevant financial disclosures. The meeting was held by the Society of Laparoendoscopic Surgeons.
BOSTON – Total laparoscopic hysterectomy had fewer complications and a shorter length of stay among morbidly obese women with uterine cancer, compared with an abdominal approach, according to findings presented at the annual Minimally Invasive Surgery Week.
“We wanted to look at current trends and see if we’re doing more the abdominal route or adopting more minimally invasive surgery, but also find out what obesity has to do with it,” Emad Mikhail, MD, of the University of South Florida in Tampa, said in an interview. “Morbidly obese patients are a really vulnerable group of patients; they have a lot of medical comorbidities, and when they need surgery they have an increased risk of having poor perioperative outcomes because of their BMI [body mass index].”
More than half of the cases were total laparoscopic hysterectomy (1,025), a third were total abdominal hysterectomy (672), about 12% were laparoscopic assisted vaginal hysterectomy (248), and less than 3% were total vaginal hysterectomy (57).
Comparing total abdominal and total laparoscopic hysterectomy – the two most commonly performed type of hysterectomy in the study – median operative times were notably higher in total laparoscopic hysterectomy: 171 minutes versus 150 minutes (P less than .05). But the laparoscopic approach had a shorter length of stay, a lower rate of hospital readmissions, and fewer surgical complications.
Within the total laparoscopic hysterectomy cohort, length of stay averaged 1 day. Dr. Mikhail reported that this cohort also had 14 blood transfusions, 13 superficial surgical site infections, 5 deep incisional surgical site infections, and 41 readmissions within 30 days, all of which were significantly lower than in the total abdominal hysterectomy cohort (P less than .05).
Mean BMI was similar in the two groups, with 34.0 in the total abdominal hysterectomy cohort and 33.7 in the total laparoscopic hysterectomy cohort.
“As the BMI goes up, more [minimally invasive surgery] is adopted, which is a great finding,” Dr. Mikhail said. “It actually serves the purpose of vulnerable patients. Instead of having an increase in perioperative morbidity, they should benefit more from a [minimally invasive surgery] approach, which this study is showing.”
Next, Dr. Mikhail said he wants to tease out what types of procedures subspecialists are performing among morbidly obese patients with uterine cancer. This type of data collection would be easier, he added, if minimally invasive gynecologic surgeons had their own taxonomy code.
“Without a code, we cannot pull data and see if being a fellowship-trained, minimally invasive surgeon has a benefit for patients,” he said. “Are those surgeons offering more minimally invasive techniques for morbidly obese patients?”
Dr. Mikhail reported having no relevant financial disclosures. The meeting was held by the Society of Laparoendoscopic Surgeons.
BOSTON – Total laparoscopic hysterectomy had fewer complications and a shorter length of stay among morbidly obese women with uterine cancer, compared with an abdominal approach, according to findings presented at the annual Minimally Invasive Surgery Week.
“We wanted to look at current trends and see if we’re doing more the abdominal route or adopting more minimally invasive surgery, but also find out what obesity has to do with it,” Emad Mikhail, MD, of the University of South Florida in Tampa, said in an interview. “Morbidly obese patients are a really vulnerable group of patients; they have a lot of medical comorbidities, and when they need surgery they have an increased risk of having poor perioperative outcomes because of their BMI [body mass index].”
More than half of the cases were total laparoscopic hysterectomy (1,025), a third were total abdominal hysterectomy (672), about 12% were laparoscopic assisted vaginal hysterectomy (248), and less than 3% were total vaginal hysterectomy (57).
Comparing total abdominal and total laparoscopic hysterectomy – the two most commonly performed type of hysterectomy in the study – median operative times were notably higher in total laparoscopic hysterectomy: 171 minutes versus 150 minutes (P less than .05). But the laparoscopic approach had a shorter length of stay, a lower rate of hospital readmissions, and fewer surgical complications.
Within the total laparoscopic hysterectomy cohort, length of stay averaged 1 day. Dr. Mikhail reported that this cohort also had 14 blood transfusions, 13 superficial surgical site infections, 5 deep incisional surgical site infections, and 41 readmissions within 30 days, all of which were significantly lower than in the total abdominal hysterectomy cohort (P less than .05).
Mean BMI was similar in the two groups, with 34.0 in the total abdominal hysterectomy cohort and 33.7 in the total laparoscopic hysterectomy cohort.
“As the BMI goes up, more [minimally invasive surgery] is adopted, which is a great finding,” Dr. Mikhail said. “It actually serves the purpose of vulnerable patients. Instead of having an increase in perioperative morbidity, they should benefit more from a [minimally invasive surgery] approach, which this study is showing.”
Next, Dr. Mikhail said he wants to tease out what types of procedures subspecialists are performing among morbidly obese patients with uterine cancer. This type of data collection would be easier, he added, if minimally invasive gynecologic surgeons had their own taxonomy code.
“Without a code, we cannot pull data and see if being a fellowship-trained, minimally invasive surgeon has a benefit for patients,” he said. “Are those surgeons offering more minimally invasive techniques for morbidly obese patients?”
Dr. Mikhail reported having no relevant financial disclosures. The meeting was held by the Society of Laparoendoscopic Surgeons.
Key clinical point:
Major finding: Total laparoscopic hysterectomy had shorter length of stay, fewer transfusions, fewer surgical site infections, and fewer readmissions, compared with total abdominal hysterectomy (P less than .05).
Data source: Retrospective review of data on 2,002 morbidly obese patients with uterine cancer in the ACS-NSQIP database.
Disclosures: Dr. Mikhail reported having no relevant financial disclosures.
Influenza vaccine highly beneficial for people with type 2 diabetes
Individuals with type 2 diabetes should receive the seasonal influenza vaccines annually, as doing so significantly mitigates their chances of being hospitalized for – or dying from – cardiovascular complications such as stroke, heart failure, and myocardial infarction.
“Studies assessing influenza vaccine effectiveness in people with diabetes are scarce and have shown inconclusive results,” wrote Eszter P. Vamos, MD, PhD, of Imperial College London and her coauthors in a study published in the Canadian Medical Association Journal. “None of the previous studies adjusted for residual confounding, and most of them reported composite endpoints such as admission to hospital for any cause.”
Each year included was divided into four seasons: preinfluenza season (Sept. 1 through the date of influenza season starting); influenza season (date of season onset as defined by national surveillance data through 4 weeks after the determined date of season ending); postinfluenza season (from the end of influenza season through April 30); and summer season (May 1 through Aug. 31). The primary outcomes were defined as hospital admissions for acute myocardial infarction, stroke, heart failure, pneumonia or influenza, and all-cause death, comparing between those who received their seasonal influenza vaccines and those who did not.
Following adjustment to account for any possible residual confounding, individuals who received their influenza vaccines were found to have a 19% reduction in their rate of hospital admissions for acute myocardial infarction (incidence rate ratio, 0.81; 95% confidence interval, 0.62-1.04), a 30% reduction in admissions for stroke (IRR, 0.70; 95% CI, 0.53-0.91), a 22% reduction in admissions for heart failure (IRR, 0.78; 95% CI, 0.65-0.92), a 15% reduction in admissions for either pneumonia or influenza (IRR, 0.85; 95% CI, 0.74-0.99), and a 24% lower death rate than those who had not been vaccinated (IRR, 0.76; 95% CI, 0.65-0.83).
“Our study provides valuable information on the long-term average benefits of influenza vaccine in people with type 2 diabetes,” the authors concluded, adding that “These findings underline the importance of influenza vaccination as part of comprehensive secondary prevention in this high-risk population.”
The study was supported by National Institute of Health Research. Dr. Vamos and her coauthors did not report any relevant financial disclosures.
Individuals with type 2 diabetes should receive the seasonal influenza vaccines annually, as doing so significantly mitigates their chances of being hospitalized for – or dying from – cardiovascular complications such as stroke, heart failure, and myocardial infarction.
“Studies assessing influenza vaccine effectiveness in people with diabetes are scarce and have shown inconclusive results,” wrote Eszter P. Vamos, MD, PhD, of Imperial College London and her coauthors in a study published in the Canadian Medical Association Journal. “None of the previous studies adjusted for residual confounding, and most of them reported composite endpoints such as admission to hospital for any cause.”
Each year included was divided into four seasons: preinfluenza season (Sept. 1 through the date of influenza season starting); influenza season (date of season onset as defined by national surveillance data through 4 weeks after the determined date of season ending); postinfluenza season (from the end of influenza season through April 30); and summer season (May 1 through Aug. 31). The primary outcomes were defined as hospital admissions for acute myocardial infarction, stroke, heart failure, pneumonia or influenza, and all-cause death, comparing between those who received their seasonal influenza vaccines and those who did not.
Following adjustment to account for any possible residual confounding, individuals who received their influenza vaccines were found to have a 19% reduction in their rate of hospital admissions for acute myocardial infarction (incidence rate ratio, 0.81; 95% confidence interval, 0.62-1.04), a 30% reduction in admissions for stroke (IRR, 0.70; 95% CI, 0.53-0.91), a 22% reduction in admissions for heart failure (IRR, 0.78; 95% CI, 0.65-0.92), a 15% reduction in admissions for either pneumonia or influenza (IRR, 0.85; 95% CI, 0.74-0.99), and a 24% lower death rate than those who had not been vaccinated (IRR, 0.76; 95% CI, 0.65-0.83).
“Our study provides valuable information on the long-term average benefits of influenza vaccine in people with type 2 diabetes,” the authors concluded, adding that “These findings underline the importance of influenza vaccination as part of comprehensive secondary prevention in this high-risk population.”
The study was supported by National Institute of Health Research. Dr. Vamos and her coauthors did not report any relevant financial disclosures.
Individuals with type 2 diabetes should receive the seasonal influenza vaccines annually, as doing so significantly mitigates their chances of being hospitalized for – or dying from – cardiovascular complications such as stroke, heart failure, and myocardial infarction.
“Studies assessing influenza vaccine effectiveness in people with diabetes are scarce and have shown inconclusive results,” wrote Eszter P. Vamos, MD, PhD, of Imperial College London and her coauthors in a study published in the Canadian Medical Association Journal. “None of the previous studies adjusted for residual confounding, and most of them reported composite endpoints such as admission to hospital for any cause.”
Each year included was divided into four seasons: preinfluenza season (Sept. 1 through the date of influenza season starting); influenza season (date of season onset as defined by national surveillance data through 4 weeks after the determined date of season ending); postinfluenza season (from the end of influenza season through April 30); and summer season (May 1 through Aug. 31). The primary outcomes were defined as hospital admissions for acute myocardial infarction, stroke, heart failure, pneumonia or influenza, and all-cause death, comparing between those who received their seasonal influenza vaccines and those who did not.
Following adjustment to account for any possible residual confounding, individuals who received their influenza vaccines were found to have a 19% reduction in their rate of hospital admissions for acute myocardial infarction (incidence rate ratio, 0.81; 95% confidence interval, 0.62-1.04), a 30% reduction in admissions for stroke (IRR, 0.70; 95% CI, 0.53-0.91), a 22% reduction in admissions for heart failure (IRR, 0.78; 95% CI, 0.65-0.92), a 15% reduction in admissions for either pneumonia or influenza (IRR, 0.85; 95% CI, 0.74-0.99), and a 24% lower death rate than those who had not been vaccinated (IRR, 0.76; 95% CI, 0.65-0.83).
“Our study provides valuable information on the long-term average benefits of influenza vaccine in people with type 2 diabetes,” the authors concluded, adding that “These findings underline the importance of influenza vaccination as part of comprehensive secondary prevention in this high-risk population.”
The study was supported by National Institute of Health Research. Dr. Vamos and her coauthors did not report any relevant financial disclosures.
Key clinical point:
Major finding: Vaccination resulted in a 19% reduction in myocardial infarction, 30% reduction in stroke, 22% reduction in heart failure, and 15% reduction in pneumonia or influenza, compared with those who went unvaccinated, after adjusting.
Data source: Retrospective cohort study of 124,503 adults with type 2 diabetes for 7 years, starting in 2003-2004 and going through 2009-2010.
Disclosures: Study supported by the National Institute of Health Research. Authors report no relevant financial disclosures.
Robotic surgery boasts fewer postoperative complications in radical hysterectomy
BOSTON – Robot-assisted radical hysterectomy is just as safe, or perhaps safer, than open surgery, according to a new study that examined perioperative and postoperative outcomes with long-term follow-ups for both types of procedures.
“Robotic surgery has been expanding for the last 20 years, but still the recurrence rate with cancer patients is missing data because very few studies are published; they don’t have long-term oncologic outcomes, and if [the technology] works properly we have to put it into the literature,” M. Bilal Sert, MD, of Oslo University, said at the annual Minimally Invasive Surgery Week.
Dr. Sert and his coinvestigators identified 215 women who underwent either open or robot-assisted radical hysterectomy between November 2005 and December 2012. All of the procedures were elective and the robot-assisted operations were performed using the da Vinci robotic surgical platform. After excluding neoadjuvant cases, which totaled 19, the researchers looked at data on 196 patients (122 open radical hysterectomy cases and 74 robot-assisted radical hysterectomy cases).
On average, operating time for open radical hysterectomy was 171 minutes, versus 263 minutes for robot-assisted radical hysterectomy. However, the robotic surgery arm had lower mean estimated blood loss than the open surgery cohort: 80 milliliters versus 468 milliliters, respectively (P = .003). Follow-up time frames were shorter in the robotic surgery cohort by 6 months: 46 months reported for robotic surgery, compared with a 52-month average experienced by those in the open surgery cohort.
Both groups experienced recurrences, including 12 patients in the open surgery cohort (9.8%) and 9 patients in the robotic surgery cohort (12.1%) (P = .3), indicating a statistically insignificant difference. Similarly, rates of perioperative complications were 8% for open surgery and 11% for robotic surgery (P = .3), which was not significantly different.
However, rates of postoperative complications were 36% for open surgery and 12% for robotic surgery (P = .001), which was statistically significant.
“Based on our data, I can say that [robot-assisted radical hysterectomy] is safe, and in fact I prefer to use the robot,” Dr. Sert said at the meeting, which was held by the Society of Laparoendoscopic Surgeons. “Of course, robot-assisted surgery will not automatically make you a better surgeon, but on more complicated radical hysterectomy patients, it will help make the surgeon more precise.”
No funding source was disclosed for this study. Dr. Sert reported having no relevant financial disclosures.
BOSTON – Robot-assisted radical hysterectomy is just as safe, or perhaps safer, than open surgery, according to a new study that examined perioperative and postoperative outcomes with long-term follow-ups for both types of procedures.
“Robotic surgery has been expanding for the last 20 years, but still the recurrence rate with cancer patients is missing data because very few studies are published; they don’t have long-term oncologic outcomes, and if [the technology] works properly we have to put it into the literature,” M. Bilal Sert, MD, of Oslo University, said at the annual Minimally Invasive Surgery Week.
Dr. Sert and his coinvestigators identified 215 women who underwent either open or robot-assisted radical hysterectomy between November 2005 and December 2012. All of the procedures were elective and the robot-assisted operations were performed using the da Vinci robotic surgical platform. After excluding neoadjuvant cases, which totaled 19, the researchers looked at data on 196 patients (122 open radical hysterectomy cases and 74 robot-assisted radical hysterectomy cases).
On average, operating time for open radical hysterectomy was 171 minutes, versus 263 minutes for robot-assisted radical hysterectomy. However, the robotic surgery arm had lower mean estimated blood loss than the open surgery cohort: 80 milliliters versus 468 milliliters, respectively (P = .003). Follow-up time frames were shorter in the robotic surgery cohort by 6 months: 46 months reported for robotic surgery, compared with a 52-month average experienced by those in the open surgery cohort.
Both groups experienced recurrences, including 12 patients in the open surgery cohort (9.8%) and 9 patients in the robotic surgery cohort (12.1%) (P = .3), indicating a statistically insignificant difference. Similarly, rates of perioperative complications were 8% for open surgery and 11% for robotic surgery (P = .3), which was not significantly different.
However, rates of postoperative complications were 36% for open surgery and 12% for robotic surgery (P = .001), which was statistically significant.
“Based on our data, I can say that [robot-assisted radical hysterectomy] is safe, and in fact I prefer to use the robot,” Dr. Sert said at the meeting, which was held by the Society of Laparoendoscopic Surgeons. “Of course, robot-assisted surgery will not automatically make you a better surgeon, but on more complicated radical hysterectomy patients, it will help make the surgeon more precise.”
No funding source was disclosed for this study. Dr. Sert reported having no relevant financial disclosures.
BOSTON – Robot-assisted radical hysterectomy is just as safe, or perhaps safer, than open surgery, according to a new study that examined perioperative and postoperative outcomes with long-term follow-ups for both types of procedures.
“Robotic surgery has been expanding for the last 20 years, but still the recurrence rate with cancer patients is missing data because very few studies are published; they don’t have long-term oncologic outcomes, and if [the technology] works properly we have to put it into the literature,” M. Bilal Sert, MD, of Oslo University, said at the annual Minimally Invasive Surgery Week.
Dr. Sert and his coinvestigators identified 215 women who underwent either open or robot-assisted radical hysterectomy between November 2005 and December 2012. All of the procedures were elective and the robot-assisted operations were performed using the da Vinci robotic surgical platform. After excluding neoadjuvant cases, which totaled 19, the researchers looked at data on 196 patients (122 open radical hysterectomy cases and 74 robot-assisted radical hysterectomy cases).
On average, operating time for open radical hysterectomy was 171 minutes, versus 263 minutes for robot-assisted radical hysterectomy. However, the robotic surgery arm had lower mean estimated blood loss than the open surgery cohort: 80 milliliters versus 468 milliliters, respectively (P = .003). Follow-up time frames were shorter in the robotic surgery cohort by 6 months: 46 months reported for robotic surgery, compared with a 52-month average experienced by those in the open surgery cohort.
Both groups experienced recurrences, including 12 patients in the open surgery cohort (9.8%) and 9 patients in the robotic surgery cohort (12.1%) (P = .3), indicating a statistically insignificant difference. Similarly, rates of perioperative complications were 8% for open surgery and 11% for robotic surgery (P = .3), which was not significantly different.
However, rates of postoperative complications were 36% for open surgery and 12% for robotic surgery (P = .001), which was statistically significant.
“Based on our data, I can say that [robot-assisted radical hysterectomy] is safe, and in fact I prefer to use the robot,” Dr. Sert said at the meeting, which was held by the Society of Laparoendoscopic Surgeons. “Of course, robot-assisted surgery will not automatically make you a better surgeon, but on more complicated radical hysterectomy patients, it will help make the surgeon more precise.”
No funding source was disclosed for this study. Dr. Sert reported having no relevant financial disclosures.
Key clinical point:
Major finding: Postoperative complications were 36% for patients who underwent open radical hysterectomy, compared with 12% for those undergoing robot-assisted radical hysterectomy (P = .001).
Data source: Retrospective review of data on 215 patients who underwent open or robot-assisted radical hysterectomy between November 2005 and December 2012.
Disclosures: Dr. Sert reported having no relevant financial disclosures.