Proposal for a computed tomography score to predict major complications requiring hospitalization after percutaneous lung biopsy: a single-center retrospective study

CT-guided Percutaneous Lung Biopsy in Children

Peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri

Optimizing Health Care Resource Utilization in the Surgical Management of Patients With Suspected Lung Cancer

Despite the widespread use of computed tomography(CT)-guided percutaneous lung biopsy (PLB) in immunocompetent patients, the diagnostic yield and safety in solid organ transplant (SOT)recipients is unknown. The purpose of this investigation was to determine the test performance of CT-PLB in SOT recipients. We performed a 10-yr single-center, retrospective analysis among heart, lung, kidney, and liver transplant recipients. We included all adult patients who underwent a PLB of a parenchymal lung nodule following their transplantation. Within the study period, 1754 SOTs were performed, of which 45 biopsies met study criteria. Overall, the incidence of PLB in SOT was 3%.PLB established a diagnosis in 24 of 45 cases. The yield of PLB was better for combined biopsy technique (fine-needle aspiration biopsy [FNAB]) and core biopsy than for FNAB alone (odds ratio [OR]: 4.2, 95% confidence interval [CI]: 1.2, 15.6), and for lesions that were malignant (OR: 10.0, 95%CI: 1.8, 75.4) or caused by an invasive fungal infection (OR: 5.0, 95% CI:1.1, 27.9). Complications occurred in 13% (6/45) of patients. CT-guided PLB is a safe modality that provides a moderate yield for diagnosing pulmonary nodules of malignant or fungal etiology in SOT recipients.

The Silent Burden of Perioperative Myocardial Infarction After Noncardiac Surgery

The diagnosis and management of pulmonary nodules in patients with COPD are challenging, as these nodules may represent either lung cancer or other pulmonary diseases. This study aims to evaluate the efficiency of a novel laser systems (LGS)-assisted CT-guided percutaneous lung biopsy in COPD patients with pulmonary nodules. A retrospective analysis was conducted on the data of 60 COPD patients with pulmonary nodules. Thirty patients (n=30) underwent CT-guided percutaneous transthoracic lung biopsy assisted by LGS, while the remaining 30 (n=30) underwent conventional manual CT-guided percutaneous transthoracic lung biopsy. The surgical time, number of punctures, CT scan frequency, and complications were compared between the two groups. No significant differences were found between the two groups in terms of clinical characteristics, lesion size, location, puncture depth, or nodule nature. Compared to the traditional method, LGS-assisted CT-guided percutaneous lung biopsy significantly reduced the number of CT scans (2.3 ± 0.5 vs 3.2 ± 0.6, P < 0.001) and the average procedure time (12.6 ± 2.7 min vs 25.1 ± 3.4 min, P < 0.001). Additionally, the total intraoperative time per procedure was significantly reduced (25.1 ± 3.4 min vs 45.9 ± 8.8 min, P < 0.001). With the use of LGS, 73% (22/30) of the procedures hit the target on the first needle insertion, compared to only 6.7% (2/30) in the conventional group. Furthermore, there was no significant difference in the incidence of complications between the two groups. Compared to the traditional method, the use of LGS improved puncture efficiency in COPD patients, reduced the need for needle adjustments, and effectively shortened the procedure time.

A survey designed to obtain information on the indications, contraindications, complications, and methodology of percutaneous lung biopsy in the horse was sent to large animal diplomates of the American College of Veterinary Internal Medicine. Sixty-five of 190 diplomates returned the survey (response rate: 34%) and 59 of these 65 respondents (91%) indicated that they worked with horses. Forty-four diplomates had performed a percutaneous lung biopsy in 1 or more horses (i.e. 75% of those diplomates working with horses and 68% of total respondents). Clinical and radiologic diagnoses that prompted diplomates to perform percutaneous lung biopsy in the horse included a pulmonary miliary pattern (93%), suspicion of pulmonary infiltrative disease (91%), suspicion of pulmonary neoplasia (91%), suspicion of chronic obstructive pulmonary disease (COPD) (20%), and suspicion of exercise-induced pulmonary hemorrhage (EIPH) (7%). Only one of the respondents reported the use of percutaneous lung biopsy in the diagnostic workup if pneumonia was suspected, but 11% of respondents reported that suspicion of pulmonary abscessation would prompt them to perform a percutaneous lung biopsy. In contrast, a variable percentage of respondents felt there were contraindications to performance of this technique, which included neonatal septicemia (68%), pulmonary abscessation (65%), pleuropneumonia (55%) and pneumonia (42%), EIPH (41%), and COPD (26%). No respondent indicated that suspicion of neoplasia was a contraindication to percutaneous biopsy. Most common complications observed by respondents were epistaxis (68% of respondents), putative pulmonary hemorrhage (52%), tachypnea (39%), and respiratory distress (32%). Ten of 44 respondents (23%) had not seen any complications with percutaneous lung biopsy. Forty-two of 44 respondents (96%) warned owners about possible complications before performing percutaneous lung biopsy. All respondents to this question reported that they would perform percutaneous lung biopsies in horses in the future, but 4 of 41 would use the procedure only as a last resort.

To estimate second-trimester surgical abortion complication rates and to estimate the effect of past cesarean delivery on the risk of complications. Demographic, medical, and operative data were collected prospectively between October 2004 and March 2007 in an academic, urban, U.S. abortion clinic. Complication and intervention rates were calculated. Multivariable logistic regression models were used to evaluate risk factors for a major complication, hemorrhage, cervical laceration, and atony. We included 2,973 second-trimester surgical abortions. Cervical laceration (3.3%), atony (2.6%), and hemorrhage (1.0%) were the most common complications. The rate of major complications (eg, transfusion, disseminated intravascular coagulation, and reoperation) was 1.3%. In multivariable logistic regression modeling, a history of two or more cesarean deliveries was the strongest predictor for having a major complication (odds ratio [OR] 7.4, 95% confidence interval [CI] 3.4-15.8), while additional predictors included gestational age of 20 weeks or more (OR 4.4, 95% CI 2.0-11.4) and insufficient initial cervical preparation requiring further dilation (OR 2.6, 95% CI 1.2-5.4). Second-trimester surgical abortions were associated with a major complication rate of approximately 1%. A history of two or more cesarean deliveries was associated with a sevenfold increase in odds of major complication and was the strongest independent risk factor for a major complication. III.

To evaluate percutaneous transhepatic biliary drainage (PTBD) safety and efficacy in patients with perihilar cholangiocarcinoma (PCCA). This retrospective observational study included patients with PCCA and obstructive cholestasis referred for a PTBD in our institution between 2010 and 2020. Technical and clinical success rates and major complication and mortality rates one month after PTBD were used as main variables. Patients were divided and analyzed into two groups: > 30 and < 30 Comprehensive Complication Index (CCI). We also evaluated post-surgical outcomes in patients undergoing surgery. Out of 223 patients, 57 were included. Technical success rate was 87.7%. Clinical success at 1week was 83.6%, before surgery 68.2%, 80.0% at 2weeks and 86.7% at 4weeks. Mean total bilirubin (TBIL) values were 15.1mg/dL (baseline), 8.1mg/dL one week after PTBD), 6.1mg/dL (2weeks) and 2.1mg/dL (4weeks). Major complication rate was 21.1%. Three patients died (5.3%). Risk factors for major complications after the statistical analysis were: Bismuth classification (p = 0.01), tumor resectability (p = 0.04), PTBD clinical success (p = 0.04), TBIL 2weeks after PTBD (p = 0.04), a second PTBD (p = 0.01), total PTBDs (p = 0.01) and duration of drainage (p = 0.03). Major postoperative complication rate in patients who underwent surgery was 59.3%, with a median CCI of 26.2. PTBD is safe and effective in the management of biliary obstruction caused by PCCA. Bismuth classification, locally advanced tumors, and failure to achieve clinical success in the first PTBD are factors related to major complications. Our sample reported a high major postoperative complication rate, although with an acceptable median CCI.

A leadless pacemaker in the real-world setting: The Micra Transcatheter Pacing System Post-Approval Registry

This study compares 30-day outcomes following rectal prolapse repair, examining potential surgical and patient factors associated with perioperative complications. Using the NSQIP database, patients with rectal prolapse were categorized by surgical approach to repair (perineal or abdominal) and abdominal cases were further subdivided by procedure (resection compared with rectopexy alone). Univariate and multivariate analyses compared major and minor complication rates between the groups. Of 1275 patients, the perineal group (n=706, 55%) was older, with more comorbidity, than those undergoing an abdominal procedure. There were fewer minor (odd ratio (OR)=0.35; 95% confidence interval (CI), 0.20-0.60; P=0.0038) and major complications (OR=0.46; 95% CI, 0.31-0.80; P=0.0038) in the perineal compared with the abdominal cohort. There was a significant increase in major complications amongst patients undergoing a resection compared with rectopexy only (OR=2.15; 95% CI, 1.10-4.41; P=0.0299). There was no difference in major complications between abdominal rectopexy and a perineal approach, but the latter had a lower chance of minor complications (OR=0.47; 95% CI, 0.24-0.94; P=0.0287). A perineal approach is safer than an abdominal approach to the treatment of rectal prolapse. Regarding an abdominal operation, rectopexy has fewer major complications than resection.

1127 MAJOR COMPLICATIONS OF ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY SIGNIFICANTLY DECREASE AFTER 100 CASES

To compare patients' radiation exposure, technical feasibility, imaging quality and complication rate of percutaneous lung biopsies (PLBs) performed with a low-dose (LD) CT protocol under guidance of an optical navigation system. Fifty-two consecutive patients with suspected malignant lung lesions were enrolled and randomised into group 1 (PLBs under the guidance of the navigation system) and group 2 (PLBs under the guidance navigation system with an LD protocol). Patients' demographics, lesion features, procedure-related variables and CT image quality for group 2 were recorded and compared. Technical success was 100 % in both groups. The radiation dose to patients' chest was significantly lower in group 2 than in group 1 (group 1: mean TDLP 206 ± 59 mGy·cm, ~ 3.5 ± 1.0 mSv; group 2: 54.2 ± 46.2 mGy·cm, ~ 0.92 ± 0.78 mSv; P < 0.0001). The PNX rate was 12 % in group 1 and 11.1 % in group 2. The haemoptysis rate was 8.0 % in group 1 and 3.7 % in group 2. CT image quality obtained in group 2 was always rated as adequate and as excellent in 15 cases (56.0 %). An optical navigation system with LD CT protocol is useful for performing lung biopsies with decreased patient radiation exposure. • Navigation systems are useful tools in percutaneous imaging-guided procedures. • For lung biopsies, low-dose (LD) CT protocols may be used. • Combining LD protocols with optical CT navigation results in significantly reduced radiation exposure.

Percutaneous trans-thoracic lung biopsy has a crucial role in diagnosing lung lesions including lung cancer. However, there is no clear guideline regarding the needle size in percutaneous trans-thoracic lung biopsy. This study aims to evaluate the diagnostic accuracy and complication rate between two needle sizes for percutaneous trans-thoracic lung biopsy. A retrospective review of patients with lung lesions who underwent percutaneous trans-thoracic lung biopsy between November 2010 and December 2019 was performed. The demographic data, imaging finding, biopsy technique, complication and histologic outcome were recorded and analyzed. Propensity score matching was done to reduce bias in baseline characteristics. Of 377 patients who underwent percutaneous trans-thoracic lung biopsy, 331 patients had complete information. The patients were divided in two groups, comprising of 153 patients in 18G needle group and 178 patients in 20G needle group. After propensity score matching, there were 126 patients left in each group. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value for 18G needle group were 92.9%, 98.1%, 65.0%, 93.7% and 86.7%, respectively. For 20G needle group, the diagnostic accuracy, sensitivity, specificity, predictive value and negative predictive value were 96.0%, 99.0%, 83.3%, 96.2% and 95.2%, respectively. The immediate complication rate was 35.7% and 31.7% in 18G and 20 G needle groups (p= 0.505), respectively. There was no difference in diagnostic accuracy and immediate complication rates between 18G and 20G needle use for percutaneous trans-thoracic lung biopsy.

To develop and validate a simple prognostic score to predict major postoperative complications after pancreaticoduodenectomy (PD). PD still carries a high rate of severe postoperative complications. No specific score is currently available to stratify the patient's risk of major morbidity. Between 2002 and 2010, preoperative, intraoperative, and outcome data from 700 consecutive patients undergoing PD in our institution were prospectively collected in an electronic database. Major complications were defined as levels III to V of Clavien-Dindo classification. On the basis of a multivariate regression model, the score was developed using a random two-thirds of the population (n = 469) and was validated on the remaining 231 patients. Major complication rate was 16.7% (117/700). Significant predictors included in the scoring system were: pancreas texture, pancreatic duct diameter, operative blood loss, and ASA score. The mean risk of developing major postoperative complications was 7% in patients with score 0 to 3, 13% in patients with score 4 to 7, 23% in patients with score 8 to 11, and 36% in patients with score 12 to 15. In the validation population, the predicted risk of major complications was 15.2% versus a 16.9% observed risk (C-statistic index = 0.743). This new score may accurately predict a patient's postoperative outcome. Early identification of high-risk patients could help the surgeon to adopt intraoperative and postoperative strategies tailored on individual basis.