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    Online Resource
    Abstract 13534: Trends, Predictors, and Outcomes of Maternal Shock From the National Inpatient Sample 2009-2019
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
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    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Maternal shock is an important contributor to severe maternal morbidity and mortality. Although there is some data on hypovolemic shock in pregnancy, the literature on maternal shock is remarkably limited. Methods: Data from the National Inpatient Sample with delivery hospitalizations from 2009 to 2019 were used for the data extraction. Diagnosis codes from the International Classification of Diseases, 9 th and 10th Revision for common cardiovascular disease (CVD) conditions, adverse pregnancy and fetal outcomes, and delivery complications including shock, were used. Multivariable logistic regression was performed to assess the predictors and outcomes associated with maternal shock. Results: A total of 41,573,217 delivery hospitalizations were analyzed, of which 13,217 were complicated by maternal shock. The trend of maternal shock was seen to rise from 20 to 45 per 100,000 hospitalizations over the study period (Fig 1A). Traditional cardiovascular risk factors and diseases (e.g., hypertension and heart failure) were significant predictors of maternal shock(Fig 1B). The presence of coagulopathy (Odds Ratio [OR]: 16.2, 95% CI: 15.4-17.0) and peripheral arterial disease (OR: 6.4, 95% CI: 4.9-8.2) were strong predictors of maternal shock. All-cause in-hospital mortality (3.82%), pre-eclampsia (10.78%) and cardiac arrest (5.69%), (all p 〈 0.001), were adverse outcomes that were significantly associated with maternal shock. Conclusions: Overall, the trend of maternal shock was seen to increase more than 2-fold per 100,000 hospitalizations over the 10-year study period. Patients hospitalized for delivery with co-morbid CVD conditions such as heart failure, coagulopathy, and peripheral arterial disease are at an increased risk of developing maternal shock and must be monitored more closely. Subsequent research should focus on characterizing the types of shock and treatment strategies in this population.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.13534
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 2
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    Online Resource
    2794 Subtotal Cholecystectomy Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  American Journal of Gastroenterology Vol. 114, No. 1 ( 2019-10), p. S1543-S1544
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    In: American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 114, No. 1 ( 2019-10), p. S1543-S1544
    Abstract: Subtotal cholecystectomies have become a viable alternative to converting laparoscopic cholecystectomies to open cholecystectomies in complicated gallbladder etiologies. There are two subtypes of subtotal cholecystectomies: fenestrating and reconstituting. Fenestrating subtotal cholecystectomy requires an internal suture of the cystic duct with removal of most of the gallbladder. Reconstituting subtotal cholecystectomy creates a gallbladder remnant. Bile leak is a common adverse outcome of subtotal cholecystectomies. ERCP is the standard intervention for high output bile leaks. METHODS: This was a retrospective analysis of patients at Coney Island Hospital who underwent any cholecystectomy during January 2010 to December 2018. The inclusion criterion was patients who underwent subtotal cholecystectomy. The exclusion criteria was any patient who underwent prior ERCP or sphincterotomy. We reviewed patient’s age, initial WBC, alkaline phosphatase, total bilirubin, AST, ALT, total output of JP drain, duration of JP drain, and hospitalization length. Data was analyzed using XTabs, ANOVA, and T-test using Prism and SAS software. RESULTS: 1423 cholecystectomies performed at Coney Island Hospital during this period. Of these, 106 were subtotal cholecystectomies: 11 were reconstituting and 96 were fenestrating. 34 subtotal cholecystectomies required ERCP intervention. Fenestrating subtotal cholecystectomies were associated with higher total bile output from JP drain and longer duration of JP drain. Cases requiring ERCP intervention were associated with larger bile output from JP drain, higher total bilirubin, and longer hospitalization duration. 68 of the fenestrated subtypes were left with an open cystic duct without internal closure. CONCLUSION: ERCP has been demonstrated to be an effective intervention in treating post operative bile leaks in cases showing large JP drain output and increased total bilirubin on initial presentation. However, a majority of subtotal cholecystectomies can be managed without intervention. We noted that 68 of the 96 fenestrating subtotal cholecystectomies had the cystic ducts remain open instead of the traditional internal suture. Cystic duct obliteration or severe inflammation may impede suturing. Regardless, close monitoring of JP drain output is recommended. Our research concludes that there are better outcomes with reconstituting subtotal cholecystectomies and fenestrating subtotal cholecystectomies in which there was an internal suture placed at the cystic duct.
    Type of Medium: Online Resource
    ISSN: 0002-9270 , 1572-0241
    URL: Article
    DOI: 10.14309/01.ajg.0000600708.10755.58
    RVK:
    XA 18920
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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