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  1. Article ; Online: Outcomes of surgery in patients 90 years of age and older: A retrospective cohort study.

    Siam, Baha / Cooper, Lisa / Orgad, Ran / Esepkina, Olga / Kashtan, Hanoch

    Surgery

    2022  Volume 171, Issue 5, Page(s) 1365–1372

    Abstract: Background: Important trade-offs of risks versus benefits of surgery need to be discussed with older adults, in particular nonagenarians who are candidates for surgery. Data that examine specific outcomes of surgical interventions in this age group are ... ...

    Abstract Background: Important trade-offs of risks versus benefits of surgery need to be discussed with older adults, in particular nonagenarians who are candidates for surgery. Data that examine specific outcomes of surgical interventions in this age group are sparse. We aimed to evaluate the clinical presentation and postoperative outcomes of nonagenarians undergoing surgery.
    Methods: A retrospective cohort study of consecutive patients 90 years of age and older who underwent surgery between 2014 and 2018 in general surgical ward of a large-volume academic center. Subgroups were designed according to type of surgery (elective versus emergency surgery) and diagnosis (oncology versus non-oncology). Preoperative assessments included Malnutrition Universal Screening Tool, Norton Scale, Morse Scale, Katz, and Lawton-Brody indices.
    Results: A total of 198 nonagenarians underwent surgery, of which 38% were elective and 62% were emergency surgery. Median follow-up was 26 months. More patients in the elective group compared with the emergency group had oncology diagnoses (42.1% and 14.7%, respectively, P < .001), resided preoperatively at home (93.4% and 77.9%, respectively, P = .003), and were functionally independent (71.1% and 41.8%, respectively, P = .0005). Postoperative 30-day mortality frequency was 6.6% in the elective group and 39.3% in the emergency group (P < .001). Two-year survival frequency of non-oncology group was 72.7% in elective surgeries and 40.6% in emergency surgeries (P < .001). Two-year survival frequency of oncology group was 37% in elective surgeries and 27.8% in emergency surgeries (P = .12).
    Conclusion: Elective surgery in adults aged 90 and above can be safely performed with acceptable 2-year outcomes. Emergency surgery for oncology diagnoses carries dismal outcomes, so palliative approaches should be considered.
    MeSH term(s) Aged ; Aged, 80 and over ; Elective Surgical Procedures/adverse effects ; Humans ; Postoperative Complications/etiology ; Retrospective Studies
    Language English
    Publishing date 2022-01-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2021.09.030
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  2. Article ; Online: Some Nursing Screening Tools Can Be Used to Assess High-Risk Older Adults Who Undergo Colorectal Surgery for Cancer.

    Cooper, Lisa / Siam, Baha / Sagee, Aviv / Orgad, Ran / Levi, Yochai / Wasserberg, Nir / Beloosesky, Yichayaou / Kashtan, Hanoch

    Clinical interventions in aging

    2020  Volume 15, Page(s) 1505–1511

    Abstract: Aim: Life expectancy and incidence of cancer among older adults are increasing. The aim of this study was to assess whether routinely used nursing screening tools can predict surgical outcomes in older adults with colorectal cancer.: Methods: Data of ...

    Abstract Aim: Life expectancy and incidence of cancer among older adults are increasing. The aim of this study was to assess whether routinely used nursing screening tools can predict surgical outcomes in older adults with colorectal cancer.
    Methods: Data of patients who underwent elective colorectal cancer surgery at Rabin Medical Center during the years 2014-2016 were collected retrospectively. Patients were divided into study group (age 80-89 y), and control group (age 60-69 y) for comparing surgical outcomes and six-month mortality. In the study group, screening tool scores were evaluated as potential predictors of surgical outcomes. These included Malnutrition Universal Screening Tool (MUST), Admission Norton Scale Scores (ANSS), Morse Fall Scale (MFS), and Charlson Co-morbidity Index (CCI).
    Results: The study group consisted of 77 patients, and the control group consisted of 129 patients. Postoperative mortality and morbidity were similar in both groups. Nursing screening tools did not predict immediate postoperative outcomes in the study group. MUST and CCI were predictors for six-month mortality. CCI score was 9.43±2.44 in those who died within six months from surgery compared to 7.07 ±1.61 in those who were alive after six months (p<0.05). Post-operative complications were not associated with increased 30-day mortality. Advanced grade complications were associated with an increased six-month mortality (RR=1.37, 95% CI 0.95-1.98, p=0.013).
    Conclusion: Different screening tools for high-risk older adults who are candidates for surgery have been developed, with the caveat of necessitating skilled physicians and resources such as time. Routinely used nursing screening tools may be helpful in better patient selection and informed decision making. These tools, specifically MUST and CCI who were found to predict six-month survival, can be used to additionally identify high-risk patients by the nursing staff and promote further evaluation. This can be a valuable tool in multidisciplinary and patient-centered care.
    MeSH term(s) Aged ; Aged, 80 and over ; Colorectal Neoplasms/surgery ; Colorectal Surgery/statistics & numerical data ; Comorbidity ; Digestive System Surgical Procedures/adverse effects ; Elective Surgical Procedures/statistics & numerical data ; Female ; Humans ; Incidence ; Male ; Mass Screening ; Middle Aged ; Nursing Assessment/methods ; Postoperative Complications/diagnosis ; Postoperative Complications/nursing ; Retrospective Studies
    Language English
    Publishing date 2020-08-25
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2364924-0
    ISSN 1178-1998 ; 1176-9092
    ISSN (online) 1178-1998
    ISSN 1176-9092
    DOI 10.2147/CIA.S258992
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  3. Article ; Online: Outcomes of interval appendectomy in comparison with appendectomy for acute appendicitis.

    Al-Kurd, Abbas / Mizrahi, Ido / Siam, Baha / Kupietzky, Amram / Hiller, Nurith / Beglaibter, Nahum / Eid, Ahmed / Mazeh, Haggi

    The Journal of surgical research

    2018  Volume 225, Page(s) 90–94

    Abstract: Background: Traditionally, patients treated conservatively for periappendiceal abscess or phlegmon would subsequently undergo interval appendectomy (IA); however, recent evidence has shed doubt on the necessity of this procedure. This study aimed to ... ...

    Abstract Background: Traditionally, patients treated conservatively for periappendiceal abscess or phlegmon would subsequently undergo interval appendectomy (IA); however, recent evidence has shed doubt on the necessity of this procedure. This study aimed to assess the outcomes of patients who underwent IA, in comparison with those operated acutely for appendicitis.
    Materials and methods: A retrospective analysis identified patients who underwent IA between 2000 and 2016. Their course and outcomes were compared with those of our previously published cohort of patients who underwent appendectomy for acute appendicitis.
    Results: During the study period, 106 patients underwent IA. Their mean age was 39.7 ± 16.2 y, and 60.4% were females. In their index admission, 75.5% presented with abscesses. IA was performed successfully in all patients, and no patient required colectomy. Pathology demonstrated neoplastic lesions in 6/106, but only one was malignant. IA patients were compared with a cohort of 1649 acute appendectomy patients. This group was significantly younger (33.7 ± 13.3 y). Operation time was comparable between the groups (46.0 ± 26.2 versus 42.7 ± 20.9 min, respectively, P = 0.33). In the IA group, significantly more laparoscopic operations were performed (100% versus 93.9%), but with a higher conversion rate to open (1.9% versus 0.13%, P < 0.001). Although the overall complication rate was comparable, more intraoperative complications (2.8% versus 0.3%, P < 0.001) and deep/organ-space surgical site infections (surgical site infection; 4.7% versus 1.2%, P = 0.003) were reported in the IA group.
    Conclusions: IA can be a challenging procedure and should not be performed on a routine basis. However, neoplasia must be actively ruled out, particularly in the older age group.
    MeSH term(s) Abscess/etiology ; Abscess/therapy ; Adult ; Age Factors ; Appendectomy/adverse effects ; Appendectomy/methods ; Appendectomy/statistics & numerical data ; Appendiceal Neoplasms/diagnosis ; Appendiceal Neoplasms/epidemiology ; Appendiceal Neoplasms/pathology ; Appendicitis/complications ; Appendicitis/therapy ; Appendix/pathology ; Appendix/surgery ; Cellulitis/etiology ; Cellulitis/therapy ; Conservative Treatment/adverse effects ; Conservative Treatment/methods ; Conversion to Open Surgery/statistics & numerical data ; Female ; Humans ; Intraoperative Complications/epidemiology ; Intraoperative Complications/etiology ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Laparoscopy/statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Operative Time ; Retrospective Studies ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2018-02-21
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2018.01.012
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    Zs.A 178: Show issues Location:
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  4. Article ; Online: Comparison of Appendectomy Outcomes Between Senior General Surgeons and General Surgery Residents.

    Siam, Baha / Al-Kurd, Abbas / Simanovsky, Natalia / Awesat, Haitham / Cohn, Yahav / Helou, Brigitte / Eid, Ahmed / Mazeh, Haggi

    JAMA surgery

    2017  Volume 152, Issue 7, Page(s) 679–685

    Abstract: Importance: In some centers, the presence of a senior general surgeon (SGS) is obligatory in every procedure, including appendectomy, while in others it is not. There is a relative paucity in the literature of reports comparing the outcomes of ... ...

    Abstract Importance: In some centers, the presence of a senior general surgeon (SGS) is obligatory in every procedure, including appendectomy, while in others it is not. There is a relative paucity in the literature of reports comparing the outcomes of appendectomies performed by unsupervised general surgery residents (GSRs) with those performed in the presence of an SGS.
    Objective: To compare the outcomes of appendectomies performed by SGSs with those performed by GSRs.
    Design, setting, and participants: A retrospective analysis was performed of all patients 16 years or older operated on for assumed acute appendicitis between January 1, 2008, and December 31, 2015. The cohort study compared appendectomies performed by SGSs and GSRs in the general surgical department of a teaching hospital.
    Main outcomes and measures: The primary outcome measured was the postoperative early and late complication rates. Secondary outcomes included time from emergency department to operating room, length of surgery, surgical technique (open or laparoscopic), use of laparoscopic staplers, and overall duration of postoperative antibiotic treatment.
    Results: Among 1649 appendectomy procedures (mean [SD] patient age, 33.7 [13.3] years; 612 female [37.1%]), 1101 were performed by SGSs and 548 by GSRs. Analysis demonstrated no significant difference between the SGS group and the GSR group in overall postoperative early and late complication rates, the use of imaging techniques, time from emergency department to operating room, percentage of complicated appendicitis, postoperative length of hospital stay, and overall duration of postoperative antibiotic treatment. However, length of surgery was significantly shorter in the SGS group than in the GSR group (mean [SD], 39.9 [20.9] vs 48.6 [20.2] minutes; P < .001).
    Conclusions and relevance: This study demonstrates that unsupervised surgical residents may safely perform appendectomies, with no difference in postoperative early and late complication rates compared with those performed in the presence of an SGS.
    MeSH term(s) Adult ; Anti-Bacterial Agents/administration & dosage ; Appendectomy/adverse effects ; Appendicitis/surgery ; Clinical Competence ; Female ; General Surgery/education ; Humans ; Internship and Residency ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/etiology ; Retrospective Studies ; Surgeons ; Surgical Staplers ; Time-to-Treatment ; Treatment Outcome ; Young Adult
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2017-04-19
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2017.0578
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  5. Article ; Online: Conversion of Laparoscopic Adjustable Gastric Banding to Gastric Bypass: a Comparison to Primary Gastric Bypass.

    Al-Kurd, Abbas / Grinbaum, Ronit / Abubeih, Ala'a / Siam, Baha / Ghanem, Muhammad / Mazeh, Haggi / Mizrahi, Ido / Beglaibter, Nahum

    Obesity surgery

    2017  Volume 28, Issue 6, Page(s) 1519–1525

    Abstract: Introduction: Laparoscopic adjustable gastric banding (LAGB) has a considerable failure rate. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the rescue options. This study aims to compare the complication rates and outcomes between LAGB ... ...

    Abstract Introduction: Laparoscopic adjustable gastric banding (LAGB) has a considerable failure rate. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the rescue options. This study aims to compare the complication rates and outcomes between LAGB converted to LRYGB and primary LRYGB.
    Materials and methods: A retrospective analysis was performed in all patients converted from LAGB to LRYGB between January 2007 and March 2017. This group was compared to a matched cohort of primary LRYGB patients operated during the same period. Early and late complications, weight loss, and improvement of comorbidities were analyzed.
    Results: One hundred sixty-one revisional LRYGB patients were compared to a similar number of primary LRYGB patients. Preoperative age, gender distribution, weight, and BMI were comparable. Mean operative time was longer in the revisional group (137.7 vs. 112.7 min, respectively, P < 0.001). The overall early complication rates were comparable between the groups (7.5 vs. 11.8%, P = 0.16), including postoperative leak rate (0.62%). Follow-up of at least 6 months was attained in 78% of the patients. Revisional cases demonstrated less weight loss (61.5 vs. 73.5%EWL, respectively, P = 0.004) and slightly less improvement of comorbidities (75.0 vs. 85.7%, respectively, P = 0.09). The late complication rate was comparable (8.1 vs. 8.1%, P = 1.0).
    Conclusion: Albeit longer operating time, revision of LAGB to LRYGB is a safe procedure, with similar complication rates when compared to primary LRYGB. Although revisional LRYGB does result in less weight loss than primary LRYGB, the procedure's safety makes it a very plausible option as a rescue operation for failed LAGB.
    MeSH term(s) Adult ; Cohort Studies ; Conversion to Open Surgery/adverse effects ; Conversion to Open Surgery/methods ; Female ; Gastric Bypass/adverse effects ; Gastric Bypass/methods ; Gastric Bypass/statistics & numerical data ; Gastroplasty/adverse effects ; Gastroplasty/methods ; Gastroplasty/statistics & numerical data ; Humans ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Laparoscopy/statistics & numerical data ; Male ; Middle Aged ; Obesity, Morbid/epidemiology ; Obesity, Morbid/surgery ; Operative Time ; Patient Readmission/statistics & numerical data ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Postoperative Period ; Reoperation/methods ; Reoperation/statistics & numerical data ; Retrospective Studies ; Treatment Failure ; Treatment Outcome ; Weight Loss ; Young Adult
    Language English
    Publishing date 2017-12-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1070827-3
    ISSN 1708-0428 ; 0960-8923
    ISSN (online) 1708-0428
    ISSN 0960-8923
    DOI 10.1007/s11695-017-3047-1
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    Zs.A 3381: Show issues Location:
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  6. Article ; Online: Delayed Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis: Is it Time for a Change?

    Yuval, Jonathan B / Mizrahi, Ido / Mazeh, Haggi / Weiss, Daniel J / Almogy, Gidon / Bala, Miklosh / Kuchuk, Eran / Siam, Baha / Simanovsky, Natalia / Eid, Ahmed / Pikarsky, Alon J

    World journal of surgery

    2017  Volume 41, Issue 7, Page(s) 1762–1768

    Abstract: Background: Our aim was to evaluate the advantages and limitations of delayed laparoscopic cholecystectomy (LC) in a tertiary center.: Materials and methods: A retrospective analysis of all patients admitted to our institution with acute calculous ... ...

    Abstract Background: Our aim was to evaluate the advantages and limitations of delayed laparoscopic cholecystectomy (LC) in a tertiary center.
    Materials and methods: A retrospective analysis of all patients admitted to our institution with acute calculous cholecystitis (ACC) between January 2003 and December of 2012 was performed. Data collected included patient demographics and comorbidities, presenting symptoms, laboratory findings, imaging results, length of stay (LOS), time to surgery, and surgical complications.
    Results: A total of 1078 patients were admitted with ACC. There were 593 females (55%), and the mean age was 57 ± 0.6 years. Mean LOS at initial admission, re-admission until surgery, and following surgery was 7.9 ± 0.2, 1.5 ± 0.1, and 3.4 ± 0.2 days, respectively. Percutaneous cholecystostomy (PC) tube was inserted in 24% of the patients. Only 640 (59%) patients eventually underwent LC. Mean time to surgery was 97 ± 9.8 days, and 16.4% of patients were readmitted in this time period resulting in a mean total LOS of 10.6 ± 0.2 days. Conversion rate to open surgery was 5.8% and bile duct injury occurred in 1.1%. Postoperative complications occurred in 9.8% of the patients, and 30-day mortality was 0.6%. Patients with more severe inflammation according to Tokyo Criteria grade were more likely to undergo PC, were more likely to be readmitted while waiting for LC, and also had more postoperative complications.
    Conclusions: Delayed LC is associated with significant loss of follow-up, long LOS, and higher than expected use of PC. Conversion rates are lower than in the literature while rates of bile duct injury and mortality are comparable. We believe these data as well as the available literature are sufficient to change our hospital policy regarding the surgical treatment of ACC from delayed to early same admission surgery in appropriate cases.
    Language English
    Publishing date 2017-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-017-3928-4
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