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Article ; Online: EDITORIAL COMMENT.

Minervini, Andrea / Tellini, Riccardo / Paparella, Laura / Carini, Marco

2019 Volume 133, Page(s) 31

MeSH term(s)	Cystectomy ; Frailty ; Humans ; Urinary Bladder
Language	English
Publishing date	2019-05-28
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	192062-5
ISSN	1527-9995 ; 0090-4295
ISSN (online)	1527-9995
ISSN	0090-4295
DOI	10.1016/j.urology.2019.04.058
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Article: The criteria of "inoperability".

Romagnoli, Stefano / Paparella, Laura / Boninsegni, Paolo

Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace

2017 Volume 87, Issue 2, Page(s) 851

Abstract: In the literature, the term "inoperable" mainly refers to two specific clinical aspects: cancer staging and technical difficulty/impossibility in performing. In light of this clarification, the statement "the patient cannot be anesthetized" has no ... ...

Abstract	In the literature, the term "inoperable" mainly refers to two specific clinical aspects: cancer staging and technical difficulty/impossibility in performing. In light of this clarification, the statement "the patient cannot be anesthetized" has no medical foundation. On the contrary, the physicians have to carefully stratify the perioperative risk and optimize the patients' preoperative clinical status. In order to perform a precise risk stratification, the European Society of Cardiology and the European Society of Anaesthesiology have joined and published the guidelines for the perioperative cardiovascular management of patients scheduled to undergo non-cardiac surgery. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) represents the most complete and accurate prediction tool so far. It includes 21 preoperative factors relating to demographics, comorbidities and procedures able to predict outcomes based on preoperative risk factors such as death, cardiac complications, pneumonia, and acute kidney injury. The present article will address aspects related to common aspects concerning modifiable and non-modifiable that should be addressed in every patient to whom elective surgery has been scheduled.
MeSH term(s)	Acute Kidney Injury ; Aged ; Cardiology/organization & administration ; Comorbidity ; Death ; Europe/epidemiology ; Heart Diseases/complications ; Heart Diseases/epidemiology ; Heart Diseases/surgery ; Humans ; Neoplasm Staging ; Neoplasms/surgery ; Perioperative Period/methods ; Perioperative Period/standards ; Pneumonia/epidemiology ; Pneumonia/etiology ; Postoperative Complications ; Practice Guidelines as Topic ; Predictive Value of Tests ; Quality Improvement ; Risk Assessment/methods ; Risk Factors
Language	English
Publishing date	2017-07-18
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1160940-0
ISSN	1122-0643 ; 1120-0391
ISSN	1122-0643 ; 1120-0391
DOI	10.4081/monaldi.2017.851
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Article ; Online: Risk factors for difficult Laryngeal Mask Airway LMA-Supreme™ (LMAS) placement in adults: a multicentric prospective observational study in an Italian population.

DI Filippo, Alessandro / Adembri, Chiara / Paparella, Laura / Esposito, Clelia / Tofani, Lorenzo / Perez, Ylenia / DI Giacinto, Ida / Micaglio, Massimo / Sorbello, Massimiliano

Minerva anestesiologica

2021 Volume 87, Issue 5, Page(s) 533–540

Abstract: Background: Supraglottic airway devices (SADs) are precious tools for airway management in both routine and rescue situations; few studies have analyzed the risk factors for their difficult insertion.: Methods: The aim of this study was to identify ... ...

Abstract	Background: Supraglottic airway devices (SADs) are precious tools for airway management in both routine and rescue situations; few studies have analyzed the risk factors for their difficult insertion. Methods: The aim of this study was to identify the risk factors for difficult insertion for a specific SAD, the Laryngeal Mask Airway LMA-Supreme™ (LMAS). This was a prospective multicentric observational study on a cohort of Italian adult patients receiving general anesthesia for elective surgery. The possible causes of difficulty in LMAS placement (difficulty in insertion or unsatisfactory ventilation) were identified based on literature and on the opinion of international airway management experts. A dedicated datasheet was prepared to collect patients' data, including anthropometric-parameters and parameters for the prediction of difficult airway management, as well as technical choices for the use of LMAS. Data were analyzed to discover the risk factors for difficult LMAS placement and the association between each risk factor and the proportion of incorrect positioning was evaluated through the relative risk and its confidence interval. Results: Four hundred thirty-two patients were enrolled; seventy required two or more attempts to insert the LMAS; nine required a change of strategy. At multivariate analysis, the following factors were significantly associated with difficult LMAS placement: Mallampati III-IV with either phonation or not; inter-incisor distance < 3 cm; reduced neck mobility; no administration of neuromuscular blocking agents (NMBAs). Conclusions: The alignment of the laryngeal and pharyngeal axes seems to facilitate the procedure, together with NMBA administration; on the contrary, Mallampati grade III-IV are associated with difficult LMAS placement.
MeSH term(s)	Adult ; Airway Management ; Humans ; Italy ; Laryngeal Masks ; Prospective Studies ; Risk Factors
Language	English
Publishing date	2021-02-16
Publishing country	Italy
Document type	Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.20.15001-6
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Article: Novel Biomarkers for Early Detection of Acute Kidney Injury and Prediction of Long-Term Kidney Function Decline after Partial Nephrectomy.

Allinovi, Marco / Sessa, Francesco / Villa, Gianluca / Cocci, Andrea / Innocenti, Samantha / Zanazzi, Maria / Tofani, Lorenzo / Paparella, Laura / Curi, Dritan / Cirami, Calogero Lino / Campi, Riccardo / Mari, Andrea / Ognibene, Agostino / Lorubbio, Maria / Fanelli, Alessandra / Romagnoli, Stefano / Romagnani, Paola / Minervini, Andrea

Biomedicines

2023 Volume 11, Issue 4

Abstract: Background: Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful. However, early prediction of a long-term eGFR decline may be an even more important goal. Our aim was to identify and compare serum [creatinine, kineticGFR, ...

Abstract	Background: Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful. However, early prediction of a long-term eGFR decline may be an even more important goal. Our aim was to identify and compare serum [creatinine, kineticGFR, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL)] and urinary (NephroCheck, NGAL, proteinuria, albuminuria, acantocytes at urinary sediment) predictors of AKI that might efficiently predict long-term GFR decline after robotic Nephron-Spearing Surgery (rNSS). Methods: Monocentric prospective observational study. Patients scheduled for rNSS for suspected localized Renal Cell Carcinoma from May 2017 to October 2017 were enrolled. Samples were collected preoperatively and postoperatively (timepoints: 4 h, 10 h, 24 h, 48 h), while kidney function was re-assessed up to 24 months. Results: 38 patients were included; 16 (42%) developed clinical AKI. The eGFR decline at 24 months was more pronounced after postoperative AKI (-20.75 vs. -7.20, Conclusions: NephroCheck and kineticGFR have emerged as promising noninvasive, accurate, and early biomarkers of postoperative AKI and long-term GFR decline after rNSS. Combining NephroCheck and kineticGFR in clinical practice would allow to identify high risk of postoperative AKI and long-term GFR decline as early as 10 h after surgery.
Language	English
Publishing date	2023-03-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines11041046
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Article: Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians' perception and practice.

Villa, Gianluca / De Rosa, Silvia / Scirè Calabrisotto, Caterina / Nerini, Alessandro / Saitta, Thomas / Degl'Innocenti, Dario / Paparella, Laura / Bocciero, Vittorio / Allinovi, Marco / De Gaudio, Angelo R / Ostermann, Marlies / Romagnoli, Stefano

Perioperative medicine (London, England)

2021 Volume 10, Issue 1, Page(s) 13

Abstract: Background: Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians' attitude toward the ... ...

Abstract	Background: Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians' attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods: Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m Results: A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion: PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration: ClinicalTrials.gov , NCT04341974 .
Language	English
Publishing date	2021-05-25
Publishing country	England
Document type	Journal Article
ZDB-ID	2683800-X
ISSN	2047-0525
ISSN	2047-0525
DOI	10.1186/s13741-021-00184-6
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Article: Chronic pain after breast surgery: incidence, associated factors, and impact on quality of life, an observational prospective study.

Villa, Gianluca / Mandarano, Raffaele / Scirè-Calabrisotto, Caterina / Rizzelli, Valeria / Del Duca, Martina / Montin, Diego Pomarè / Paparella, Laura / De Gaudio, A Raffaele / Romagnoli, Stefano

Perioperative medicine (London, England)

2021 Volume 10, Issue 1, Page(s) 6

Abstract: Background: Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk ... ...

Abstract	Background: Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients' function and quality of life is also described. Methods: Women aged 18+ undergoing oncological or reconstructive breast surgery from Jan until Apr 2018 at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was measured at 0 h, 3 h, 6 h, 12 h, 24 h, 48 h, and 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis. Results: Among the 307 patients considered in this study, the incidence of CPBS was 28% [95% CI 23.1-33.4%]. Results from the logistic regression analysis suggest that axillary surgery (OR [95% CI], 2.99 [1.13-7.87], p = 0.03), preoperative use of pain medications (OR [95% CI], 2.04 [1.20-3.46], p = 0.01), and higher dynamic NRS values at 6 h postoperatively (OR [95% CI], 1.28 [1.05-1.55], p = 0.01) were all independent predictors for CPBS. Conclusions: Chronic pain after breast surgery is a frequent complication. In our cohort, long-term use of analgesics for pre-existing chronic pain, axillary surgery, and higher dynamic NRS values at 6 h postoperatively were all factors associated with increased risk of developing CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicisation. Trial registration: ClinicalTrials.gov registration NCT04309929 .
Language	English
Publishing date	2021-02-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2683800-X
ISSN	2047-0525
ISSN	2047-0525
DOI	10.1186/s13741-021-00176-6
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Article ; Online: Outcome predictors and quality of life of severe burn patients admitted to intensive care unit

Buoninsegni Laura / Paparella Laura / Gianesello Lara / Pavoni Vittorio / Barboni Elisabetta

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 18, Iss 1, p

2010 Volume 24

Abstract: Abstract Background Despite significant medical advances and improvement in overall mortality rate following burn injury, the treatment of patients with extensive burns remains a major challenge for intensivists. We present a study aimed to evaluate the ... ...

Abstract	Abstract Background Despite significant medical advances and improvement in overall mortality rate following burn injury, the treatment of patients with extensive burns remains a major challenge for intensivists. We present a study aimed to evaluate the short- and the long-term outcomes of severe burn patients (total body surface area, TBSA > 40%) treated in a polyvalent intensive care unit (ICU) and to assess the quality of life of survivors, one year after the injury using the EuroQol-5D (EQ-5D) questionnaire. Methods A prospective-observational study was performed in an ICU of a University-affiliated hospital. Logistic regression analysis was used to identify the factors predicting in-hospital mortality. The EQ-5D questionnaire was used to asses participant's long term self-reported general health. Results During a period of five years, 50 patients participated in the study. Their mean age was 53.8 ± 19.8; they had a mean of %TBSA burned of 54.5 ± 18.1. 44% and 10% of patients died in the ICU and in the ward after ICU discharge, respectively. Baux index, SAPS II and SOFA on admission to the ICU, infectious and respiratory complications, and time of first burn wound excision were found to have a significant predictive value for hospital mortality. The level of health of all survivors was worse than before the injury. Problems in the five dimensions studied were present as follows: mobility (moderate 68.5%; extreme 0%), self-care (moderate 21%; extreme 36.9%), usual activities (moderate 68.5%; extreme 21%), pain/discomfort (moderate 68.5%; extreme 10.5%), anxiety/depression (moderate 36.9%; extreme 42.1%). Conclusions In severe burn patients, Baux index, severity of illness on admission to the ICU, complications, and time of first burn wound excision were the major contributors to hospital mortality. Quality of life was influenced by consequences of injury both in psychological and physical health.
Keywords	Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	360
Language	English
Publishing date	2010-04-01T00:00:00Z
Publisher	BioMed Central
Document type	Article ; Online
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Article ; Online: Health-related quality of life before planned admission to intensive care

Tadini Laura / Paparella Laura / Felisatti Giovanna / Davanzo Elena / Bertacchini Sara / Capuzzo Maurizia / Alvisi Raffaele

Health and Quality of Life Outcomes, Vol 8, Iss 1, p

memory over three and six months

2010 Volume 103

Abstract: Abstract Background The validity of Health-Related Quality of Life (HRQOL) recalled by ICU admitted patients have not been published. The aim of this study was to compare the baseline HRQOL measured before surgery and ICU admission with that recalled at ... ...

Abstract	Abstract Background The validity of Health-Related Quality of Life (HRQOL) recalled by ICU admitted patients have not been published. The aim of this study was to compare the baseline HRQOL measured before surgery and ICU admission with that recalled at 3 and 6 months in a population of patients with planned ICU admission after surgery. Methods This prospective study was performed in three Italian centres on patients who had undergone General, Orthopaedic or Urologic surgery. All adult patients with planned ICU admission between October 2007 and July 2008 were considered for enrolment. At hospital admission, the Mini Mental Status Examination and EuroQoL (EQ) questionnaire (referring to the last two weeks) were administered to the patients who consented. Three and six months after ICU admission, the researchers administered by phone the EQ questionnaire and Post-Traumatic Stress Syndrome 14 questions Inventory, asking the patients to rate their HRQOL before surgery and ICU admission. Past medical history demographic and clinical ICU-related variables were collected. Statistical analysis Chi-square test and non parametric statistics were used to compare groups of patients. The EQ-5D was transformed in the time trade-off (TTO) to obtain a continuous variable, subsequently analysed using the Intraclass Correlation Coefficient (ICC). Results Of the 104 patients assessed at baseline and discharged from the hospital, 93 had the EQ administered at 3 months, and 89 at 6 months. The ICC for TTO recalled at 3 months vs pre-ICU TTO was 0.851, and that for TTO recalled at 6 months vs pre-ICU TTO was 0.833. The ICC for the EQ-VAS recalled at 3 months vs pre-ICU EQ-VAS was 0.648, and that for the EQ-VAS recalled at 6 months vs pre-ICU EQ-VAS was 0.580. Forty-two (45%) patients assessed at 3 months gave the same score in all EQ-5D items as at baseline. They underwent mainly orthopaedic surgery (p 0.011), and perceived the severity of their illness as lower (p 0.009) than patients scoring differently at 3 months in comparison ...
Keywords	Computer applications to medicine. Medical informatics ; R858-859.7
Subject code	616
Language	English
Publishing date	2010-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Outcome and quality of life of elderly critically ill patients: an Italian prospective observational study.

Pavoni, Vittorio / Gianesello, Lara / Paparella, Laura / Buoninsegni, Laura Tadini / Mori, Emanuele / Gori, Gabriele

Archives of gerontology and geriatrics

2012 Volume 54, Issue 2, Page(s) e193–8

Abstract: The demand of critical care admissions to intensive care unit (ICU) is projected to rise in the next decade. The aim of this study was to evaluate short and long-term mortality and quality of life (QoL) of elderly patients (80 years and older) admitted ... ...

Abstract	The demand of critical care admissions to intensive care unit (ICU) is projected to rise in the next decade. The aim of this study was to evaluate short and long-term mortality and quality of life (QoL) of elderly patients (80 years and older) admitted to two ICUs for medical conditions, abdominal surgery (planned and unplanned) and orthopedic surgery for hip fractures, over a 6-year period. Three months and one year after ICU discharge, patients or family members were contacted by telephone to obtain follow-up information using the EuroQoL questionnaire. The data were compared with an age-matched of the Italian population. Two hundred eighty-eight patients were included in the study. ICU mortality of medical (14.8%) and unplanned surgical patients (26.4%) was higher than that of planned surgical (5.0%) and orthopedic patients (2.5%), as was hospital mortality (27.7% vs. 50.0% vs. 5.0% vs. 14.3%). Three months and 12 months mortality rates after ICU discharge were 40.7% and 61.1% in medical patients, 70.5% and 76.4% in unplanned surgical patients, 20.0% and 30.0% in planned surgical patients, 36.2% and 46.2% in orthopedic patients. QoL measures revealed that, one year after ICU discharge, medical and orthopedic patients had significantly more severe problems vis-à-vis mobility, self-care and activity than abdominal surgical patients and control population. Type of admission was the independent risk factor associated with ICU and long-term mortality, whereas age 90 year and older was associated with long-term mortality. Orthopedic surgery for hip fractures seems to influence QoL similar to medical diseases.
MeSH term(s)	Age Factors ; Aged, 80 and over ; Critical Illness/epidemiology ; Critical Illness/mortality ; Critical Illness/psychology ; Female ; Humans ; Intensive Care Units/statistics & numerical data ; Italy/epidemiology ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Prospective Studies ; Quality of Life ; Surgical Procedures, Operative/mortality ; Surgical Procedures, Operative/psychology ; Surgical Procedures, Operative/statistics & numerical data ; Treatment Outcome
Language	English
Publishing date	2012-03
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	603162-6
ISSN	1872-6976 ; 0167-4943
ISSN (online)	1872-6976
ISSN	0167-4943
DOI	10.1016/j.archger.2011.11.013
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Article ; Online: Health-related quality of life before planned admission to intensive care: memory over three and six months.

Capuzzo, Maurizia / Bertacchini, Sara / Davanzo, Elena / Felisatti, Giovanna / Paparella, Laura / Tadini, Laura / Alvisi, Raffaele

Health and quality of life outcomes

2010 Volume 8, Page(s) 103

Abstract: Background: The validity of Health-Related Quality of Life (HRQOL) recalled by ICU admitted patients have not been published. The aim of this study was to compare the baseline HRQOL measured before surgery and ICU admission with that recalled at 3 and 6 ...

Abstract	Background: The validity of Health-Related Quality of Life (HRQOL) recalled by ICU admitted patients have not been published. The aim of this study was to compare the baseline HRQOL measured before surgery and ICU admission with that recalled at 3 and 6 months in a population of patients with planned ICU admission after surgery. Methods: This prospective study was performed in three Italian centres on patients who had undergone General, Orthopaedic or Urologic surgery. All adult patients with planned ICU admission between October 2007 and July 2008 were considered for enrolment. At hospital admission, the Mini Mental Status Examination and EuroQoL (EQ) questionnaire (referring to the last two weeks) were administered to the patients who consented. Three and six months after ICU admission, the researchers administered by phone the EQ questionnaire and Post-Traumatic Stress Syndrome 14 questions Inventory, asking the patients to rate their HRQOL before surgery and ICU admission. Past medical history demographic and clinical ICU-related variables were collected. Statistical analysis: Chi-square test and non parametric statistics were used to compare groups of patients. The EQ-5D was transformed in the time trade-off (TTO) to obtain a continuous variable, subsequently analysed using the Intraclass Correlation Coefficient (ICC). Results: Of the 104 patients assessed at baseline and discharged from the hospital, 93 had the EQ administered at 3 months, and 89 at 6 months. The ICC for TTO recalled at 3 months vs pre-ICU TTO was 0.851, and that for TTO recalled at 6 months vs pre-ICU TTO was 0.833. The ICC for the EQ-VAS recalled at 3 months vs pre-ICU EQ-VAS was 0.648, and that for the EQ-VAS recalled at 6 months vs pre-ICU EQ-VAS was 0.580. Forty-two (45%) patients assessed at 3 months gave the same score in all EQ-5D items as at baseline. They underwent mainly orthopaedic surgery (p 0.011), and perceived the severity of their illness as lower (p 0.009) than patients scoring differently at 3 months in comparison with baseline. Conclusions: The patients with planned ICU admission have a good memory of their health status as measured by EQ-5D in the period preceding surgery and ICU admission, especially at three months.
MeSH term(s)	Adult ; Female ; Health Status ; Hospitalization ; Humans ; Intensive Care Units ; Italy ; Male ; Mental Recall ; Orthopedic Procedures/psychology ; Psychiatric Status Rating Scales ; Psychometrics ; Quality of Life ; Stress Disorders, Post-Traumatic/psychology ; Surveys and Questionnaires ; Time Factors ; Urologic Surgical Procedures/psychology
Language	English
Publishing date	2010-09-16
Publishing country	England
Document type	Comparative Study ; Journal Article ; Multicenter Study
ISSN	1477-7525
ISSN (online)	1477-7525
DOI	10.1186/1477-7525-8-103
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