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Article ; Online: Multiple logistic regression model to predict bile leak associated with subtotal cholecystectomy.

Lunevicius, Raimundas / Nzenwa, Ikemsinachi C

2023 Volume 37, Issue 7, Page(s) 5405–5413

Abstract: Background: There are no prediction models for bile leakage associated with subtotal cholecystectomy (STC). Therefore, this study aimed to generate a multivariable prediction model for post-STC bile leakage and evaluate its overall performance.: ... ...

Abstract	Background: There are no prediction models for bile leakage associated with subtotal cholecystectomy (STC). Therefore, this study aimed to generate a multivariable prediction model for post-STC bile leakage and evaluate its overall performance. Methods: We analysed prospectively managed data of patients who underwent STC by a single consultant surgeon between 14 May 2013 and 21 December 2021. STC was schematised into four variants with five subvariants and classified broadly as closed-tract or open-tract STC. A contingency table was used to detect independent risk factors for bile leakage. A multiple logistic regression analysis was used to generate a model. Discrimination and calibration statistics were computed to assess the accuracy of the model. Results: A total of 81 patients underwent the STC procedure. Twenty-eight patients (35%) developed bile leakage. Of these, 18 patients (64%) required secondary surgical intervention. Multivariable logistic regression revealed two independent predictors of post-STC bile leak: open-tract STC (odds ratio [OR], 7.07; 95% confidence interval [CI], 2.191-25.89; P = 0.0170) and acute cholecystitis (OR, 5.449; 95% CI, 1.584-23.48; P = 0.0121). The area under the receiver-operating characteristic curve was 82.11% (95% CI, 72.87-91.34; P < 0.0001). Tjur's pseudo-R Conclusions: Open-tract STC and acute cholecystitis are the most reliable predictors of bile leakage associated with STC. Future prospective, multicentre studies with higher statistical power are needed to generate more specific and externally validated prediction models for post-STC bile leaks.
MeSH term(s)	Humans ; Logistic Models ; Bile ; Cholecystectomy/adverse effects ; Cholecystectomy/methods ; Postoperative Complications/etiology ; Cholecystitis, Acute/etiology ; Cholecystectomy, Laparoscopic/adverse effects ; Retrospective Studies
Language	English
Publishing date	2023-04-04
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-023-10049-2
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Article ; Online: Exploring the inclusion of anatomical variation in medical education.

Nzenwa, Ikemsinachi C / Iqbal, Hassan A / Bazira, Peter J

Anatomical sciences education

2023 Volume 16, Issue 3, Page(s) 531–546

Abstract: The role of anatomical variability in safe clinical practice is underappreciated. A lack of familiarity of anatomical variations is at the center of a multitude of medical and surgical errors. The recent rise in litigation due to such errors suggests ... ...

Abstract	The role of anatomical variability in safe clinical practice is underappreciated. A lack of familiarity of anatomical variations is at the center of a multitude of medical and surgical errors. The recent rise in litigation due to such errors suggests that patient care may be compromised. This makes the knowledge of anatomical variation essential to medical education. Empirical studies were identified by searching several databases and repositories, and the Medical Education Research Quality Instrument (MERSQI) was used to assess study quality. Eight studies were eligible for this systematic review; three of which were conference abstracts. Thematic summary of these studies yielded six themes namely: (1) importance of anatomical variation in medical education; (2) the ideal time to introduce anatomical variation in medical education; (3) important anatomical variations to include in medical education; (4) approaches to teaching anatomical variation; (5) assessing knowledge on anatomical variation; (6) barriers to including anatomical variation in medical education. Including anatomical variations in medical education would improve clinical reasoning and surgical outcomes. Following the completion of this review, three recommendations were made: (1) increasing the emphasis of anatomical variation in medical education; (2) developing more resources for anatomical variation education; (3) investigating the implications of lack of knowledge of anatomical variation in medical education through further research.
MeSH term(s)	Humans ; Anatomy/education ; Databases, Factual ; Education, Medical ; Educational Status ; Knowledge
Language	English
Publishing date	2023-01-24
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	2483491-9
ISSN	1935-9780 ; 1935-9772
ISSN (online)	1935-9780
ISSN	1935-9772
DOI	10.1002/ase.2254
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Article ; Online: A nationwide analysis of gallbladder surgery in England between 2000 and 2019.

Lunevicius, Raimundas / Nzenwa, Ikemsinachi C / Mesri, Mina

Surgery

2021 Volume 171, Issue 2, Page(s) 276–284

Abstract: Background: There are no reports on nationwide trends in subtotal cholecystectomy (STC) and cholecystostomy in England. We hypothesized that, as in the United States, a substantial increase in the utilization of these surgical procedures, over time, may ...

Abstract	Background: There are no reports on nationwide trends in subtotal cholecystectomy (STC) and cholecystostomy in England. We hypothesized that, as in the United States, a substantial increase in the utilization of these surgical procedures, over time, may be observed. We aimed to generate a reliable report on 4 of the most common gallbladder surgical procedures in England to allow cross-procedure comparisons and highlight significant changes in the management of benign gallbladder disease over time. Methods: We obtained data from NHS Digital and extracted population estimates from the Office of National Statistics. We examined the trends in the use of STC, cholecystostomy, cholecystolithotomy and total cholecystectomy (TC) between 2000 and 2019. Results: Of the 1,234,319 gallbladder surgeries performed, TC accounted for 96.8% (n = 1,194,786) and the other 3 surgeries for 3.2% (n = 39,533). The total number of gallbladder surgeries performed annually increased by 80.4% from 2000 to 2019. We detected increases in the counts of cholecystostomies by 723.1% (n = 290 in 2000 vs n = 2,387 in 2019) and STCs by 716.6% (n = 217 in 2000 vs n = 1,772 in 2019). Consequently, there was a decrease in the ratio of TC to STC (180:1 in 2000 vs 38:1 in 2019). A similar decrease was observed in the ratio of cholecystectomy to cholecystostomy (135:1 in 2000 vs 29:1 in 2019). Conclusion: Increased utilization of STC and cholecystostomy was detected in England. These findings highlight the importance of regular monitoring of nationwide trends in gallbladder surgery and the associated clinical outcomes.
MeSH term(s)	Adolescent ; Adult ; Age Distribution ; Aged ; Child ; Child, Preschool ; Cholecystectomy/statistics & numerical data ; Cholecystectomy/trends ; Cholecystostomy/statistics & numerical data ; Cholecystostomy/trends ; England ; Female ; Gallbladder/surgery ; Gallbladder Diseases/surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Procedures and Techniques Utilization ; Retrospective Studies ; Sex Distribution ; Young Adult
Language	English
Publishing date	2021-11-12
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.2021.10.025
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Article ; Online: Risks associated with subtotal cholecystectomy and the factors influencing them: A systematic review and meta-analysis of 85 studies published between 1985 and 2020.

Nzenwa, Ikemsinachi C / Mesri, Mina / Lunevicius, Raimundas

Surgery

2021 Volume 170, Issue 4, Page(s) 1014–1023

Abstract: Background: Subtotal cholecystectomy is recognized as a rescue procedure performed in grossly suboptimal circumstances that would deem a total cholecystectomy too risky to execute. An earlier systematic review based on 30 studies published between 1985 ... ...

Abstract	Background: Subtotal cholecystectomy is recognized as a rescue procedure performed in grossly suboptimal circumstances that would deem a total cholecystectomy too risky to execute. An earlier systematic review based on 30 studies published between 1985 and 2013 concluded that subtotal cholecystectomy had a morbidity rate comparable to that of total cholecystectomy. This systematic review appraises 17 clinical outcomes in patients undergoing subtotal cholecystectomy. Methods: The study protocol was registered with the International Prospective Register for Systematic Reviews (CRD42020172808). MEDLINE, Embase, Cochrane bibliographic databases, and Google Scholar were used to identify papers published between 1985 and June 2020. Data related to the surgical setting, approach, intervention on the hepatic wall of the gallbladder, type of completion of subtotal cholecystectomy, year of study, and study design were collected. Seventeen clinical outcomes were considered. Meta-analyses were performed using a random-effects model, and the effect size was presented as risk ratios with 95% confidence intervals. Results: From 1,017 records, 85 eligible studies were identified and included. These included 3,645 patients who underwent subtotal cholecystectomy. Laparoscopic (80.1%, n = 2,918) and reconstituting (74.6%, n = 2,719) approaches represented the majority of all subtotal cholecystectomy cases. Seven (0.2%) cases of injury to the bile duct were reported. Bile leak was reported in 506 (13.9%) patients. Reconstituting subtotal cholecystectomy was associated with a lower risk for 11 clinical outcomes. Open subtotal cholecystectomy was associated with an increased rate of 30-day mortality and wound infections. Conclusion: Subtotal cholecystectomy is associated with significant morbidity. Laparoscopic and reconstituting surgery may reduce the risks of some perioperative complications and long-term sequelae after subtotal cholecystectomy.
MeSH term(s)	Cholecystectomy, Laparoscopic/adverse effects ; Cholecystectomy, Laparoscopic/methods ; Cholecystolithiasis/surgery ; Gallbladder/surgery ; Global Health ; Humans ; Morbidity/trends ; Periodicals as Topic ; Postoperative Complications/epidemiology ; Retrospective Studies ; Survival Rate/trends
Language	English
Publishing date	2021-04-27
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2021.03.036
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Article ; Online: Evaluating the Patient and Setting-Specific Factors That Influenced the Quality of Informed Consent in a Retrospective Cohort of Subtotal Cholecystectomy Patients.

Mesri, Mina / Nzenwa, Ikemsinachi C / Lunevicius, Raimundas

Journal of laparoendoscopic & advanced surgical techniques. Part A

2020 Volume 31, Issue 1, Page(s) 77–84

Abstract: Introduction: ...

Abstract	Introduction:
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cholecystectomy/ethics ; Cholecystectomy/methods ; Female ; Humans ; Informed Consent/standards ; Informed Consent/statistics & numerical data ; Male ; Medical Audit ; Middle Aged ; Patient Education as Topic/methods ; Patient Education as Topic/standards ; Patient Education as Topic/statistics & numerical data ; Practice Patterns, Physicians'/standards ; Practice Patterns, Physicians'/statistics & numerical data ; Quality Assurance, Health Care ; Retrospective Studies ; Young Adult
Keywords	covid19
Language	English
Publishing date	2020-07-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	1381909-4
ISSN	1557-9034 ; 1092-6429
ISSN (online)	1557-9034
ISSN	1092-6429
DOI	10.1089/lap.2020.0376
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Zs.A 3246: Show issues

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Article ; Online: Patience is key: Association of surgical timing with clinical outcomes in elderly patients with sigmoid volvulus.

Arnold, Suzanne C / Rafaqat, Wardah / Abiad, May / Lagazzi, Emanuele / Hoekman, Anne H / Panossian, Vahe S / Nzenwa, Ikemsinachi C / Paranjape, Charudutt N / Velmahos, George C / Kaafarani, Haytham M A / Hwabejire, John O

American journal of surgery

2024 Volume 232, Page(s) 81–86

Abstract: Background: Current guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (> ...

Abstract	Background: Current guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (>2 days) sigmoid colectomy. Methods: 2016-2019 NRD database was queried to identify patients aged ≥65 years admitted for sigmoid volvulus who underwent sequential endoscopic decompression and sigmoid colectomy. Outcomes included mortality, complications, hospital length of stay, readmissions, and hospital costs. Results: 842 patients were included, of which 409 (48.6 %) underwent delayed sigmoid colectomy. Delayed sigmoid colectomy was associated with reduced cardiac complications (1.1 % vs 0.0 %, p = 0.045), reduced ostomy rate (38.3 % vs 29.4 %, p = 0.013), an increased overall length of stay (12 days vs 8 days, p < 0.001) and increased overall costs (27,764 dollar vs. 24,472 dollar, p < 0.001). Conclusion: In geriatric patient with sigmoid volvulus, delayed surgical resection after decompression is associated with reduced cardiac complications and reduced ostomy rate, while increasing overall hospital length of stay and costs.
MeSH term(s)	Humans ; Intestinal Volvulus/surgery ; Aged ; Female ; Male ; Colectomy/methods ; Colectomy/economics ; Sigmoid Diseases/surgery ; Aged, 80 and over ; Decompression, Surgical/economics ; Decompression, Surgical/methods ; Length of Stay/statistics & numerical data ; Retrospective Studies ; Treatment Outcome ; Postoperative Complications/epidemiology ; Time-to-Treatment/statistics & numerical data ; Time Factors
Language	English
Publishing date	2024-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2024.01.007
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Article: Evaluating the Patient and Setting-Specific Factors That Influenced the Quality of Informed Consent in a Retrospective Cohort of Subtotal Cholecystectomy Patients

Mesri, Mina / Nzenwa, Ikemsinachi C / Lunevicius, Raimundas

J. laparoendosc. adv. surg. tech., Part A

Abstract: Introduction: Cholecystectomy is the most frequently performed procedure in general surgery. The consent procedure for cholecystectomy needs to inform patients about the possibility of subtotal cholecystectomy (STC) as an alternative procedure used for " ... ...

Abstract	Introduction: Cholecystectomy is the most frequently performed procedure in general surgery. The consent procedure for cholecystectomy needs to inform patients about the possibility of subtotal cholecystectomy (STC) as an alternative procedure used for "difficult gallbladders" as it is associated with increased postoperative morbidity. We sought to determine the quality of informed consent for patients who were scheduled for cholecystectomy but underwent STC, and evaluate whether patient or procedural factors influenced the information discussed in consenting. Materials and Methods: We classified 57 components of information necessary for a patient to give informed consent for cholecystectomy. We retrospectively reviewed the consent forms of patients scheduled for conventional cholecystecomy but instead undergoing STC between 2011 and 2017. Consent quality was measured as the percentage of components completed. Subgroup analyses were conducted to determine whether age, gender, American Society of Anesthesiologists grade, setting (elective/nonelective), operation mode (open/laparoscopic), or the responsible surgeon affected consent quality. Results: Across 174 patients, just 9 (5.2%) had been informed about the possibility of undergoing STC, whereas the overall quality of consent was 37.5%. Patient and setting-specific factors affected the completion of specific consent components. Patients were more likely to receive a patient information leaflet if they were female (relative risk [RR] 2.76; 95% confidence interval [CI] 1.09-7.00), <60 years (RR 3.32; 95% CI 1.39-7.90) or undergoing laparoscopic surgery (RR 8.04; 95% CI 2.50-25.88). Conclusion: The suboptimal quality of consent and multiple inconsistencies in the information disclosed to different patient cohorts emphasize the need for a more transparent and consistent consenting process.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #32668182
Database	COVID19

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Article ; Online: Wound complications following surgery to the lymph nodes: A protocol for a systematic review and meta-analysis.

Nzenwa, Ikemsinachi C / Iqbal, Hassan A / Hardie, Claire / Smith, George E / Matteucci, Paolo L / Totty, Joshua P

PloS one

2022 Volume 17, Issue 8, Page(s) e0272490

Abstract: Background: Malignancies that spread to the lymph nodes may be identified through surgical biopsy, and treatment of metastatic disease may be through lymph node dissection. These surgeries, however, may be associated with significant adverse outcomes, ... ...

Abstract	Background: Malignancies that spread to the lymph nodes may be identified through surgical biopsy, and treatment of metastatic disease may be through lymph node dissection. These surgeries, however, may be associated with significant adverse outcomes, particularly wound complications, the true incidence of which remains unknown. Multiple studies have reported their individual rates of complications in isolation. The aim of this study will be to systematically evaluate data that presents the incidence of wound complications in patients undergoing these surgeries. Methods: We have designed and registered a protocol for a systematic review and meta-analysis of studies presenting incidence data. We will search MEDLINE, EMBASE and CENTRAL for relevant articles. Meta-analysis will be undertaken to synthesise an overall incidence of surgical site infection, wound dehiscence, haematoma and seroma. Subgroup analyses will investigate the effects of anatomical location, primary malignancy and study design on pooled incidence. Risk of bias will be evaluated for each included study using bespoke tools matched to the study design. Discussion: The results of this study will provide the incidence of wound complications and secondary complications following lymph node surgery. This will directly impact upon the consent process, and may influence the nature of future research studies aimed at reducing post-operative complications.
MeSH term(s)	Humans ; Lymph Nodes/surgery ; Meta-Analysis as Topic ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Seroma ; Surgical Wound Dehiscence/epidemiology ; Surgical Wound Dehiscence/etiology ; Surgical Wound Infection/complications ; Surgical Wound Infection/etiology ; Systematic Reviews as Topic
Language	English
Publishing date	2022-08-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0272490
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Article: Type B Lactic Acidosis in a Patient with Mantle Cell Lymphoma.

Nzenwa, Ikemsinachi C / Berquist, Margaret / Brenner, Toby J / Ansari, Aida / Al-Fadhl, Hamid D / Aboukhaled, Michael / Patel, Shivani S / Peck, Ethan E / Al-Fadhl, Mahmoud D / Thomas, Anthony V / Zackariya, Nuha / Walsh, Mark M / Bufill, Jose A

Case reports in critical care

2023 Volume 2023, Page(s) 7021123

Abstract: Type B lactic acidosis is an uncommon medical emergency in which acid production overwhelms hepatic clearance. This specific etiology of lactic acidosis occurs without organ hypoperfusion and has been most commonly described in patients with hematologic ... ...

Abstract	Type B lactic acidosis is an uncommon medical emergency in which acid production overwhelms hepatic clearance. This specific etiology of lactic acidosis occurs without organ hypoperfusion and has been most commonly described in patients with hematologic malignancies but also in patients with solid tumors. The mechanism by which cancer cells switch their glucose metabolism toward increasingly anaerobic glycolytic phenotypes has been described as the "Warburg effect." Without treating the underlying malignancy, the prognosis for patients diagnosed with malignancy-related type B lactic acidosis is extremely poor. Here, we present a case of a 66-year-old male who was diagnosed with type B lactic acidosis secondary to mantle cell lymphoma. Bicarbonate drip was started to correct the lactic acidosis. The patient was also immediately treated with rituximab chemotherapy combined with rasburicase to avoid the hyperuricemia associated with tumor lysis syndrome. He responded to the early treatment and was discharged with normal renal function. Type B lactic acidosis secondary to hematologic malignancy is important to recognize. In order to successfully treat this syndrome, early diagnosis and simultaneous treatment of the imbalance of lactic acid levels and the underlying malignancy are necessary.
Language	English
Publishing date	2023-08-16
Publishing country	United States
Document type	Case Reports
ZDB-ID	2927720-6
ISSN	2090-6439 ; 2090-6420
ISSN (online)	2090-6439
ISSN	2090-6420
DOI	10.1155/2023/7021123
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