Maria Teresa Gómez

The risk of death due to cardiorespiratory causes increases with time after right pneumonectomy: a propensity score-matched analysis †

OBJECTIVES The study aimed to compare in-hospital, 30-day and non-cancer-related 6-month death rates in a series of right and left pneumonectomy cases matched according to functional parameters. METHODS A retrospective study was conducted on a series of 263 non-small cell lung cancer patients who underwent pneumonectomy. Left and right pneumonectomy cases were matched according to propensity scores using the following variables: age, coronary artery disease, any other cardiac comorbidity and predicted postoperative forced expiratory volume in the 1st second (ppoFEV1). After matching, 89 pairs of cases were selected. In-hospital, 30-day and 6-month crude and risk-adjusted death rates not related to cancer relapse or distant metastases were calculated for right and left pneumonectomy and compared on 2-by-2 tables using odds ratios. Death hazards were estimated by Cox regression, introducing the following independent variables in the model: age, cardiac comorbidity, ppoFEV1 and occurrence of any postoperative cardiorespiratory complication or bronchial fistula. RESULTS Non-cancer-related in-hospital, 30-day and 6-month death rates were, respectively, 8.4 (3.4 in left and 13.5 in right cases; P = 0.015), 11.8 (7.8 in left and 15.7 in right cases; P = 0.10) and 18.5% (12.4 in left and 24.7 in right cases; P = 0.033). On Cox regression, age, right pneumonectomy and the occurrence of postoperative cardiorespiratory complications (but not bronchial fistula) were related to the risk of death at 6 months. CONCLUSIONS The risk of death after pneumonectomy increases with time and strongly depends on the side of the operation (it is higher after right pneumonectomy) and on the occurrence of any postoperative cardiorespiratory complication. Neither hospital nor 30-day mortality should be reported as a valid outcome after pneumonectomy since they do not represent the real risk of the operation.

The risk of bilobectomy compared with lobectomy: a retrospective analysis of a series of matched cases and controls

OBJECTIVES Bilobectomy is considered to be a risky procedure due to space mismatch between the pleural space and the remnant lung. The objective of this study was to evaluate if postoperative complications related or not to size mismatch are more frequent after bilobectomy compared with right lobectomy cases. METHODS Retrospective case-control study on a series of matched non-small-cell lung cancer patients. Cases were patients who underwent right bilobectomy (upper and middle or lower and middle) and controls, patients who underwent right upper or lower lobectomy. Cases and controls were matched by propensity scoring according to site, age, ppoFEV1, type of postoperative management (intensive physiotherapy or not), cardiac comorbidity and pT status. We selected two primary outcomes for comparison: occurrence of any cardiorespiratory complication and occurrence of any complication related to space discrepancies. For the latter, all complicated case records were reviewed and two blinded observers agreed on the probability of each complication to be related to space discrepancies. Agreement was measured by the κ statistic. The overall odds ratio (OR) and 95% confidence interval (CI) for each outcome were calculated on 2 × 2 tables for the whole population and for cases with upper or lower resections. RESULTS The study included 689 patients: 572 right lobectomy (419 upper and 153 lower) and 117 bilobectomy cases (30 upper and middle and 87 lower and middle). The overall mortality rate of the series was 2.03% (14/689), and cardiorespiratory complications were recorded in 14.4% (99/689) and space-related complications in 19.59% (135/689) cases. Both observers agreed on space-related complications in 86% of the 135 cases (κ: 0.72). After matching, 234 cases entered the study (117 with right lobectomy, including 83 lower and 34 upper, and 117 with bilobectomy, including 87 lower and 30 upper). The prevalence of cardiorespiratory complications was higher after lower and middle lobectomy compared with lower lobectomy (P = 0.0002; OR: 7.96, 95% CI: 2.19-43.16). No differences were found in death rates or in space-related complications between groups of lobectomy and bilobectomy cases. CONCLUSIONS This study failed to demonstrate a higher space-related complication rate in bilobectomy cases but cardiorespiratory complications were statistically higher after lower and middle lobectomy compared with lower lobectomy in matched cases.

Functional evaluation before lung resection: searching for a low technology test in a safer environment for the patient: a pilot study†

OBJECTIVES Stair climbing is considered the first step for functional evaluation of patients requiring anatomical lung resection who have low-predicted postoperative forced expiratory volume in the first second of expiration (FEV1) or diffusing capacity of the lungs for carbon monoxide (DLCO) values. Nevertheless, stair climbing is not performed in many centres because of structural issues or patient safety concerns. We hypothesized that comparable exercise can be obtained on an ergometric bicycle in a safer environment where any adverse event can be treated. We tried to correlate the amount of exercise performed by stair climbing and by using an ergometric bicycle in a series of patients with non-small-cell lung cancer (NSCLC) evaluated prospectively. METHODS Thirty-four consecutive patients with NSCLC who were scheduled for lung resection were prospectively enrolled to complete two low-technology exercise tests: The first one was stair climbing, and the second was a ramp test on an ergometric bicycle. For most patients (85%), both tests were performed on the same day, separated with at least 2 h of rest. The amount of exercise on the stair-climbing test (in watts: Watt 1) was calculated per patient weight, height reached on stairs and time spent. The bicycle test was performed on a Lode Corival ergometer with automatic calculation of the total work load (Watt 2). No estimation of VO 2 max was attempted. The bicycle test was conducted in an ad-hoc room fully equipped with oxygen, cardiac and blood pressure and PO 2 monitoring and resuscitation equipment. The Bland-Altman plot was used to evaluate the agreement between both tests. A linear regression model was constructed in which the power developed on the stairs was the dependent variable and the watts generated on the bicycle and patient age were the covariates. RESULTS All patients (median age: 65.5 years; range: 41-84), completed both tests without any adverse events. The number of watts was greater on the stairs tests (mean 227 vs 64 on the ergometric bicycle). The Bland-Altman plot showed agreement between tests in most cases (Pitman-Morgan test: 0.96). Work load was more dependent on age in the stairs tests (Pearson coefficient -0.72 on stairs; -0.52 on ergometric bicycle). The logistic model was highly predictive when the workload on the bicycle was corrected by the patients age ( R 2  =   0.80; Wald test <0.001). CONCLUSIONS This simple test on an ergometric bicycle shows a high correlation with the widely accepted stair-climbing test when workload results are corrected using the patients age. It could replace the stair-climbing test and has the advantage of being conducted in an environment that is safer for the patient. Nevertheless, its reliability for risk prediction needs to be adequately evaluated.

Skorts Crop Con Dos Y Top Volantes Piezas Sand Set De 5aqr6qIwx--simonjamespeacock.com

OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.

De Negro Hombros Flores Bordada M Con Blusa Descubiertos RxFUdAqRw--simonjamespeacock.com

OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.

PLANO GIMENEZ 30700 ZAPATO MUJER CAYETANO PARA nvSxn--simonjamespeacock.com

OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.

LIU S64171 LIU LIU S64171 LIU S64171 S64171 LIU JO S64171 JO JO JO LIU JO xqzX7XB--simonjamespeacock.com

OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.

W Classic UGG BOTA Mini BOT S1YXqwzq--simonjamespeacock.com

OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.

La discusión de casos por videoconferencia mejora la eficiencia de la consulta externa de cirugía torácica

OBJECTIVE The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.