Effects of Preoperative COVID-19 Status on Emergent or Urgent Colectomy Outcomes.

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 has been described as eliciting a powerful immune response. The association of coronavirus disease 2019 (COVID-19) infection with diseases requiring emergent or urgent colectomies may exacerbate the risk of surgical complications. We investigated the effect of preoperative COVID-19 infection on the clinical outcomes of patients who underwent a nonelective colectomy in 2021. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program Targeted Colectomy database for all of the patients who underwent a colectomy in 2021 and filtered for patients classified as "Urgent" or "Emergent." Two groups were created based on preoperative COVID-19 status: COVID+ (n = 242) and COVID- cohorts (n = 11,049). Several clinical variables were compared. RESULTS: Before filtering for urgent/emergent operations, a large percentage of COVID+ patients were found to have undergone an urgent or emergency colectomy (68.36% vs 25.05%). Preoperatively, these patients were more likely to be taking steroids (21.49% vs 12.41%) or have a bleeding issue requiring a transfusion (19.42% vs 11.00%). A larger percentage of infected patients returned to the operating room (14.05% vs 8.13%) and had a hospital stay >30 days (18.18% vs 5.35%). COVID-19 infection was associated with a higher rate of mortality (14.05% vs 8.08%) but did not independently predict it (odds ratio 1.25, P = 0.233), with all P ≤ 0.001. CONCLUSIONS: Urgent or emergent colectomy patients who were COVID-19+ preoperatively were more likely to present with comorbidities, which, along with the recent viral infection, contributed to markedly worse clinical outcomes, including an increased rate of mortality.

Effects of the COVID-19 Pandemic on Colectomy Outcomes for Inflammatory Bowel Disease.

OBJECTIVES: Inflammatory bowel disease (IBD) encompasses Crohn's disease (CD) and ulcerative colitis (UC). These two chronic inflammatory conditions can differ in severity, presentation, and anatomical localization, and can greatly affect quality of life if not managed properly. Given the many healthcare challenges during the coronavirus disease 2019 pandemic, we studied the effects of the pandemic and corresponding changes to medical resources on surgical outcomes for patients with IBD. METHODS: Deidentified data from patients who underwent a colectomy for CD or UC were collected from the National Surgical Quality Improvement Program database of the American College of Surgeons. We analyzed clinical factors and surgical outcomes between 2019 and 2020. RESULTS: Patients with IBD were more likely to have lost >10% of their body mass before the operation in 2020. Operations for patients with UC were significantly shorter in the first year of the pandemic. Patients with CD were less likely to have a urinary tract infection or sepsis postoperatively in 2020, whereas patients with UC were more likely to require a repeat operation. Interestingly, both patient populations were less likely to undergo an emergency operation in 2020 than in 2019. CONCLUSIONS: Colectomy outcomes for patients with CD in 2020 were similar or improved in comparison with those seen in 2019, whereas colectomies for UC saw a statistically but not clinically significant increase in the rate of repeat operations. Overall, these patients seem to have been well managed despite the coronavirus disease 2019 pandemic-induced strain on the healthcare system.

How the COVID-19 pandemic affected the severity and clinical presentation of diverticulitis.

BACKGROUND/AIMS: Single-institution studies showed that patients presented with more severe diverticulitis and underwent more emergency operations during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, we studied this trend using nationwide data from the American College of Surgeons National Surgical Quality Improvement Program database. METHODS: Patients (n = 23,383) who underwent a colectomy for diverticulitis in 2018 (control year) and 2020 (pandemic year) were selected. We compared these groups for differences in disease severity, comorbidities, perioperative factors, and complications. RESULTS: During the pandemic, colonic operations for diverticulitis decreased by 13.14%, but the rates of emergency operations (17.31% vs. 20.04%, P< 0.001) and cases with a known abscess/perforation (50.11% vs. 54.55%, P< 0.001) increased. Likewise, the prevalence of comorbidities, such as congestive heart failure, acute renal failure, systemic inflammatory response syndrome, and septic shock, were higher during the pandemic (P< 0.05). During this same period, significantly more patients were classified under American Society of Anesthesiologists classes 3, 4, and 5, suggesting their preoperative health states were more severe and life-threatening. Correspondingly, the average operation time was longer (P< 0.001) and complications, such as organ space surgical site infection, wound disruption, pneumonia, acute renal failure, septic shock, and myocardial infarction, increased (P< 0.05) during the pandemic. CONCLUSIONS: During the pandemic, surgical volume decreased, but the clinical presentation of diverticulitis became more severe. Due to resource reallocation and possibly patient fear of seeking medical attention, diverticulitis was likely underdiagnosed, and cases that would have been elective became emergent. This underscores the importance of monitoring patients at risk for diverticulitis and intervening when criteria for surgery are met.

Racial Disparities in Clinical Outcomes of Emergency Colectomies for Diverticulitis.

OBJECTIVES: The literature suggests that there are ongoing racial disparities in healthcare outcomes between patients in White and non-White populations. As such, we examined the outcomes of patients who underwent an emergency colectomy for diverticulitis. METHODS: We identified 4841 White and 590 non-White patients, which include Black/African American and Asian patients, using the 2016-2019 American College of Surgeons National Surgical Quality Improvement Program databases. We compared Black/African American and Asian patients with White patients for differences in surgical outcomes. RESULTS: Non-White patients had more comorbidities than White patients (P < 0.05). These patients underwent longer operations, developed more postoperative complications, and were more likely to have lengths of stay >30 days. When controlling for all of the covariates in multivariate logistic regression models, White race was independently associated with a 22.14% lower odds of a hospital stay >30 days compared with non-White patients (P = 0.001). CONCLUSIONS: In this study, non-White patients developed more complications than did White patients and had longer hospitalizations. These disparities represent a more complex societal issue that cannot be managed perioperatively alone.

Assessment of Risk Factors for Iatrogenic Genitourinary Injuries During a Proctectomy.

BACKGROUND: It is critical to avoid iatrogenic injuries affecting genitourinary organs in order to prevent postoperative urinary or sexual dysfunction, which lead to lengthier recovery and possibly reoperation. METHODS: Using the 2016-2019 American College of Surgeons National Quality Improvement Program (ACS NSQIP) Targeted Proctectomy Database, we collated 2577 patients with non-metastatic rectal cancer who underwent a laparoscopic or open proctectomy. Univariate analysis was used to identify differences in perioperative factors and genitourinary injuries (GUIs) between operative approaches, and multivariate logistic regression was used to identify independent risk factors for sustaining an intraoperative GUI. RESULTS: The rates of preoperative comorbidities were significantly higher among patients who received an open operation. The proportion of GUIs was also significantly higher in this patient population. Multivariate logistic regression demonstrated that patients who underwent a laparoscopic proctectomy were associated with a 51.4% lower risk of sustaining a GUI. Furthermore, >10% body weight loss in the past 6 months and ASA class 3 status were independently associated with a higher risk of GUI regardless of operation type. CONCLUSION: Patients who undergo a laparoscopic proctectomy are associated with a lower risk of GUI. On the other hand, patients with >10% body weight loss and ASA class 3: Severe Systemic Disease were associated with a higher risk of GUI.

A Single-Institution Comparison of Robot-Assisted and Conventional Laparoscopic Colorectal Surgeries.

There has been ongoing discussion regarding the superiority of robotic laparoscopic surgery (RLS) over conventional laparoscopic surgery (CLS) in many surgical subspecialties. We therefore sought to elucidate if RLS is associated with more favorable clinical outcomes than CLS among patients who underwent colorectal surgery. Using data from a high-volume single institution in New Jersey, we identified 145 patients who underwent an elective RLS or CLS sigmoid resection for colon cancer or diverticulitis in 2019 and 2020. We analyzed operation time, hospitalization cost, complications, readmissions, reoperations, and lymph node retrieval. Operation time and operation to discharge time were not significantly different among patients undergoing surgery for colon cancer (P > .05), but operation time was found to be longer in diverticulitis patients (P = .03). Additionally, RLS was significantly more costly ($86,003 ± $3520 vs. $68,277 ±$1,168, P < .001) for patients with diverticulitis. Our data demonstrate that the benefit of RLS over CLS in colon resections for diverticulitis and colon cancer is not evident due to the increased costs associated with RLS procedures.

Baseline Visual Acuity at Wet AMD Diagnosis Predicts Long-Term Vision Outcomes: An Analysis of the IRIS Registry.

BACKGROUND AND OBJECTIVE: Clinical trials in neovascular age-related macular degeneration (nAMD) demonstrate that high visual acuity (VA) can be maintained, and low VA can be improved with anti-vascular endothelial growth factor (VEGF) treatment. Few real-world data investigating the relationship between baseline VA and long-term outcomes exist. This study compares VA at diagnosis and after treatment using data from a large patient registry. PATIENTS AND METHODS: Retrospective study of IRIS Registry patients diagnosed with nAMD in one or both eyes between January 2013 and June 2017. Patients received at least two anti-VEGF injections in the study eye(s) less than 45 days apart during the study period. Primary outcomes were the percentage of eyes with 20/40 VA or better at diagnosis and association of VA at diagnosis with longer-term visual outcomes. RESULTS: The study included 162,902 eyes. Among all included eyes, 34.3% presented with 20/40 VA or better at diagnosis. Patients with 20/40 vision or better at baseline maintained a mean VA of 20/40 or better for 2 years after treatment initiation. CONCLUSIONS: Baseline VA at nAMD diagnosis predicts long-term VA outcomes. Early diagnosis before VA is adversely affected is a key factor in preserving vision in patients with nAMD. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:633-639.].

Laparoscopy in penetrating abdominal trauma is a safe and effective alternative to laparotomy.

INTRODUCTION: Diagnostic laparoscopy (DL) is an increasingly used modality when approaching penetrating abdominal trauma (PAT). Trauma surgeons can utilize this minimally invasive technique to quickly assess for injury in hemodynamically stable patients. DL with a confirmed injury can be repaired through therapeutic laparoscopy (TL) or conversion to exploratory laparotomy (EL). This study analyzes the use of laparoscopy as a first-line therapy for hemodynamically stable patients with PAT. METHODS: Data were reviewed of patients presenting with PAT between December 2006 and September 2016. A retrospective analysis was conducted to analyze demographics, baseline presentations, treatment protocols and outcomes. RESULTS: A total of 56 patients with PAT were initially treated with laparoscopy. Injuries included stab wounds (n = 48) and gunshot wounds (n = 8). Patients were divided into three groups: DL, DL to TL, and DL to EL. Ten patients (17.9%) required conversion to laparotomy (DL to EL). Of the 46 patients who did not require conversion, 33 patients (71.7%) underwent DL, while 13 patients (28.3%) required TL (DL to TL). There were no differences in postoperative complication rates between the groups (p = 0.565). The mean lengths of hospital stay for DL, DL to TL, and DL to EL were 3.1, 2.7, and 8.1 days, respectively (p = 0.038). No missed injuries or mortalities occurred in any of the groups. CONCLUSION: Laparoscopy can be utilized for hemodynamically stable patients with PAT. DL can be converted to TL in the hands of a skilled laparoscopist. In this study, we analyze the use of DL over a 10-year period in patients who presented to our level 1 trauma center with PAT. We also provide a comprehensive review of literature to create clear definitions, and to clarify a systematic stepwise approach of how to effectively perform DL and TL. This study adds to the body of literature supporting the role of laparoscopy in PAT, and advances the discussion regarding management.

Growth inhibition of pathogenic bacteria by sulfonylurea herbicides.

Emerging resistance to current antibiotics raises the need for new microbial drug targets. We show that targeting branched-chain amino acid (BCAA) biosynthesis using sulfonylurea herbicides, which inhibit the BCAA biosynthetic enzyme acetohydroxyacid synthase (AHAS), can exert bacteriostatic effects on several pathogenic bacteria, including Burkholderia pseudomallei, Pseudomonas aeruginosa, and Acinetobacter baumannii. Our results suggest that targeting biosynthetic enzymes like AHAS, which are lacking in humans, could represent a promising antimicrobial drug strategy.

Sympathetic ophthalmia.

Sympathetic ophthalmia is a rare, bilateral granulomatous panuveitis following accidental or surgical trauma to one eye. The pathophysiology is not clearly understood, but is believed to be a T-cell mediated autoimmune response. Clinical presentation most often occurs within the first year after trauma; anteriorly it manifests as a chronic or acute uveitis with mutton-fat keratic precipitates, while posteriorly it is often accompanied by yellowish-white choroidal lesions or Dalen-Fuchs nodules. The mainstay of treatment consists of systemic anti-inflammatory agents such as oral corticosteroids, or other immunosuppressive agents. Newer treatments include intravitreal injections of steroids in combination with systemic therapy, periocular injections of steroids without systemic therapy, and injections of infliximab, an anti-vascular endothelial growth factor.

In situ optical variability and relationships in the Santa Barbara Channel: implications for remote sensing.

Relationships and variability of bio-optical properties in coastal waters are investigated. Optical proxies indicate that these coastal waters are optically complex and highly variable and are categorized as follows: (1) relatively clear and dominated by high index of refraction, biogenic particles, (2) more turbid, consisting of mostly inorganic particles and little phytoplankton, (3) extremely turbid with high concentrations of inorganic particles, and (4) more turbid and dominated by biogenic particles. We present a method, alternative to traditional remote-sensing algorithms, of classifying coastal waters [the Spectral Angle Mapper (SAM)] and utilize the SAM to successfully isolate plume conditions in time series of downwelling irradiance and total absorption coefficient. We conclude with a discussion of the use of the SAM for coastal management operations.

Comparisons of optical properties of the coastal ocean derived from satellite ocean color and in situ measurements.

Satellite-derived optical properties are compared to in situ mooring and ship-based measurements at a coastal site. Comparisons include remote sensing reflectance (R(rs)), chlorophyll concentration (Chl) using two different Chl algorithms, and spectral absorption [a(pg)(lambda)] and backscattering coefficients [b(b)(555)] using three different bio-optical algorithms. For mooring/shipboard comparisons, we observed mean relative errors of 70.5%/-3.8% (SeaWiFS OC4v4), -21.4%/-49.3% (SeaWiFS Stumpf), 109.5%/13.4% (MODIS OC3m) and 0.5%/-48.9% (MODIS Stumpf) for Chl. For satellite-derived and mooring comparisons of a(pg)(412), we found mean relative errors of -69.4% (-67.1%), -52.6% (- 48.9%), and -62.7% (-65.4%) for the Arnone, GSM, and QAA algorithms for SeaWiFS (MODIS), respectively. Mean relative errors of 21.3%, 19.9%, and 16.5% were found between SeaWiFS-derived (Arnone, GSM, and QAA algorithms, respectively) and moored b(b)(555) measurements. Discrepancies in Rrs at blue wavelengths are attributed to the satellite atmospheric correction and sea surface variations of the moored radiometers. High spatial and temporal variability of bio-optical properties coupled with differences in measurement techniques (pixel versus point) contribute to inconsistencies between remotely sensed and in situ biooptical properties.

Toward closure of upwelling radiance in coastal waters.

We present three methods for deriving water-leaving radiance L(w)(lambda) and remote-sensing reflectance using a hyperspectral tethered spectral radiometer buoy (HyperTSRB), profiled spectroradiometers, and Hydrolight simulations. Average agreement for 53 comparisons between HyperTSRB and spectroradiometric determinations of L(w)(lambda) was 26%, 13%, and 17% at blue, green, and red wavelengths, respectively. Comparisons of HyperTSRB (and spectroradiometric) L(w)(lambda) with Hydrolight simulations yielded percent differences of 17% (18%), 17% (18%), and 13% (20%) for blue, green, and red wavelengths, respectively. The differences can be accounted for by uncertainties in model assumptions and model input data (chlorophyll fluorescence quantum efficiency and the spectral chlorophyll-specific absorption coefficient for the red wavelengths, and scattering corrections for input ac-9 absorption data and volume scattering function measurements for blue wavelengths) as well as radiance measurement inaccuracies [largely differences in the depth of the L(u)(lambda, z) sensor on the HyperTSRB].