Magnetic resonance non-echo planar diffusion-weighted imaging accuracy in detecting cholesteatoma in comparison with clinical and surgical findings.

OBJECTIVE: Magnetic resonance imaging utilising non-echo planar diffusion-weighted imaging is known to have high sensitivity and specificity in detecting cholesteatoma. METHOD: Data was retrospectively collected from patients who had undergone non-echo planar diffusion-weighted imaging from 1 January 2010 to 31 December 2016. The ratio of average pixel grey-scale values between the middle-ear lesion, pons and temporal lobe was used to quantify the degree of restricted diffusion and assess the statistical significance to detect cholesteatoma. RESULTS: A total of 107 patients had non-echo planar diffusion-weighted imaging during the study period. Non-echo planar diffusion-weighted imaging shows good specificity and sensitivity with an excellent positive predictive value and accuracy. Analysis of the grey-scale pixel ratio for cholesteatoma detection showed statistically significant results. CONCLUSION: Non-echo planar diffusion-weighted magnetic resonance imaging is accurate for cholesteatoma assessment. When the middle-ear lesion non-echo planar diffusion-weighted imaging intensity is higher than the ipsilateral temporal lobe, it is highly suggestive of a cholesteatoma formation.

Effect of frailty on short- and mid-term outcomes in vascular surgical patients.

BACKGROUND: Frailty is a multidimensional vulnerability resulting from age-associated decline. The impact of frailty on outcomes was assessed in a cohort of vascular surgical patients. METHODS: The study included patients aged over 65 years with length of hospital stay (LOS) greater than 2 days, who were admitted to a tertiary vascular unit over a single calendar year. Demographics, mode of admission, diagnosis, mortality, LOS and discharge destination were recorded, as well as a variety of frailty-specific characteristics. The impact of frailty on LOS, discharge destination, survival and readmission rate was assessed using multivariable regression techniques. The ability of the models to predict these outcomes was also assessed. RESULTS: In total, 413 patients of median age 77 years were followed for a median of 18 (range 12-24) months. The in-hospital, 3- and 12-month mortality rates were 3·6, 8·5 and 13·8 per cent respectively. Receiver operating characteristic (ROC) curve analysis revealed that frailty-based regression models were excellent predictors of 12-month mortality (area under the ROC curve (AUC) = 0·81), prolonged LOS (AUC = 0·79) and discharge to a care institution (AUC = 0·84). A simple additive frailty score using six key features retained strong predictive power for 12-month mortality (AUC = 0·83), discharge to a care institution (AUC = 0·78) and prolonged LOS (AUC = 0·74). This frailty score was also strongly associated with readmission rates (P < 0·001). CONCLUSION: Frailty in vascular surgery patients predicts a multiplicity of poorer outcomes. Optimal management should include identification of at-risk patients and treatment of modifiable risk factors.

Selection, thirty day outcome and costs for short stay endovascular aortic aneurysm repair (SEVAR).

BACKGROUND: Endovascular aortic aneurysm repair (EVAR) offers the potential for a reduced hospital stay. The aim of this study was to identify patients suitable for short stay EVAR (SEVAR) with a single night in hospital and document their outcome. METHOD: Patients for EVAR were assessed prospectively for SEVAR over a 21-month period using UK Day Surgery Guidelines. Joint anaesthetic and surgical approval were necessary for these patients to be included in this vascular pathway. Patients were admitted on the day of surgery with a designated care protocol for discharge the day after. RESULTS: 101 patients were assessed for SEVAR. 33 (33%) patients met the criteria for SEVAR and 27 of these (81%) were successfully discharged one day post-operatively. Total SEVAR median LOS was one day (IQR = 0) versus four days (IQR = 2) for the standard EVAR group (P < 0.0001) reducing costs from £13,360 (CI = ±1074) to £9844 (CI = ±628). Increased utilisation of SEVAR during the study period led to reduced overall average EVAR costs, £12,102(CI = ±795) to £10,330(CI = ±757). CONCLUSION: SEVAR protocol reduces hospital stay for selected patients. The outcomes from a larger cohort of such patients require further study. This would identify whether SEVAR could be expanded to more patients.