Browsing by Subject "Postoperative"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Association between plasma tau and postoperative delirium incidence and severity: a prospective observational study
    (Elsevier, 2021) Ballweg, Tyler; White, Marissa; Parker, Margaret; Casey, Cameron; Bo, Amber; Farahbakhsh, Zahra; Kayser, Austin; Blair, Alexander; Lindroth, Heidi; Pearce, Robert A.; Blennow, Kaj; Zetterberg, Henrik; Lennertz, Richard; Sanders, Robert D.; Medicine, School of Medicine
    Background: Postoperative delirium is associated with increases in the neuronal injury biomarker, neurofilament light (NfL). Here we tested whether two other biomarkers, glial fibrillary acidic protein (GFAP) and tau, are associated with postoperative delirium. Methods: A total of 114 surgical patients were recruited into two prospective biomarker cohort studies with assessment of delirium severity and incidence. Plasma samples were sent for biomarker analysis including tau, NfL, and GFAP, and a panel of 10 cytokines. We determined a priori to adjust for interleukin-8 (IL-8), a marker of inflammation, when assessing associations between biomarkers and delirium incidence and severity. Results: GFAP concentrations showed no relationship to delirium. The change in tau from preoperative concentrations to postoperative Day 1 was greater in patients with postoperative delirium (P<0.001) and correlated with delirium severity (ρ=0.39, P<0.001). The change in tau correlated with increases in IL-8 (P<0.001) and IL-10 (P=0.0029). Linear regression showed that the relevant clinical predictors of tau changes were age (P=0.037), prior stroke/transient ischaemic attack (P=0.001), and surgical blood loss (P<0.001). After adjusting for age, sex, preoperative cognition, and change in IL-8, tau remained significantly associated with delirium severity (P=0.026). Using linear mixed effect models, only tau (not NfL or IL-8) predicted recovery from delirium (P<0.001). Conclusions: The change in plasma tau was associated with delirium incidence and severity, and resolved over time in parallel with delirium features. The impact of this putative perioperative neuronal injury biomarker on long-term cognition merits further investigation.
  • Thumbnail Image
    Item
    Cohort study into the neural correlates of postoperative delirium: the role of connectivity and slow-wave activity
    (Elsevier, 2020-07) Tanabe, Sean; Mohanty, Rosaleena; Lindroth, Heidi; Casey, Cameron; Ballweg, Tyler; Farahbakhsh, Zahra; Krause, Bryan; Prabhakaran, Vivek; Banks, Matthew I.; Sanders, Robert D.; Medicine, School of Medicine
    Background: Delirium frequently affects older patients, increasing morbidity and mortality; however, the pathogenesis is poorly understood. Herein, we tested the cognitive disintegration model, which proposes that a breakdown in frontoparietal connectivity, provoked by increased slow-wave activity (SWA), causes delirium. Methods: We recruited 70 surgical patients to have preoperative and postoperative cognitive testing, EEG, blood biomarkers, and preoperative MRI. To provide evidence for causality, any putative mechanism had to differentiate on the diagnosis of delirium; change proportionally to delirium severity; and correlate with a known precipitant for delirium, inflammation. Analyses were adjusted for multiple corrections (MCs) where appropriate. Results: In the preoperative period, subjects who subsequently incurred postoperative delirium had higher alpha power, increased alpha band connectivity (MC P<0.05), but impaired structural connectivity (increased radial diffusivity; MC P<0.05) on diffusion tensor imaging. These connectivity effects were correlated (r2=0.491; P=0.0012). Postoperatively, local SWA over frontal cortex was insufficient to cause delirium. Rather, delirium was associated with increased SWA involving occipitoparietal and frontal cortex, with an accompanying breakdown in functional connectivity. Changes in connectivity correlated with SWA (r2=0.257; P<0.0001), delirium severity rating (r2=0.195; P<0.001), interleukin 10 (r2=0.152; P=0.008), and monocyte chemoattractant protein 1 (r2=0.253; P<0.001). Conclusions: Whilst frontal SWA occurs in all postoperative patients, delirium results when SWA progresses to involve posterior brain regions, with an associated reduction in connectivity in most subjects. Modifying SWA and connectivity may offer a novel therapeutic approach for delirium.
  • Thumbnail Image
    Item
    Contrast-Enhanced Ultrasound Versus Doppler Ultrasound for Detection of Early Vascular Complications of Pancreas Grafts
    (American Roentgen Ray Society, 2020-11) Swensson, Jordan; Hill, Danielle; Tirkes, Temel; Fridell, Jonathan; Patel, Aashish; Radiology and Imaging Sciences, School of Medicine
    OBJECTIVE. The purpose of this study is to compare conventional duplex ultrasound and contrast-enhanced ultrasound (CEUS) for identifying vascular abnormalities in pancreas allografts in the immediate posttransplant setting. Identification of pancreas allografts at risk of failure may impact patient care because early intervention for vascular insufficiency can lead to graft salvage. MATERIALS AND METHODS. Two radiologists who were blinded to patient outcomes performed a retrospective analysis of the postoperative Doppler ultrasound and CEUS images of 34 pancreas grafts from transplants performed between 2017 and 2019. A total of 28 patients who did not require surgical reexploration were considered the control group. Six patients had surgically proven arterial or venous abnormalities on surgical reexploration. Each radiologist scored grafts as having normal or abnormal vascularity on the basis of image sets obtained using Doppler ultrasound only and CEUS only. Comparisons of both the diagnostic performance of each modality and interobserver agreement were performed. RESULTS. Both readers showed that CEUS had increased sensitivity for detecting vascular abnormalities (83.3% for both readers) compared with Doppler ultrasound (66.7% and 50.0%). For both readers, the specificity of CEUS was similar to that of Doppler imaging (81.6% and 78.9% for reader 1 and reader 2 versus 76.3% and 84.2% for reader 1 and reader 2). For both readers, the negative predictive value of CEUS was higher than that of Doppler ultrasound (96.9% and 96.8% for reader 1 and reader 2 versus 93.5% and 91.4% for reader 1 and reader 2). Interobserver agreement was higher for CEUS than for Doppler ultrasound (κ = 0.54 vs κ = 0.28). CONCLUSION. CEUS may provide radiologists and surgeons with a means of timely and effective evaluation of pancreas graft perfusion after surgery, and it may help identify grafts that could benefit from surgical salvage.
  • Thumbnail Image
    Item
    Hydrocolloid dressing versus conventional wound care after dermatologic surgery
    (Elsevier, 2021-12-21) Holmes, Samantha P.; Rivera, Sydney; Hooper, Perry B.; Slaven, James E.; Que, Syril Keena T.; Medicine, School of Medicine
    Background: Hydrocolloid dressings (HCD) are helpful in chronic wound care, but research is limited in acute postoperative wounds. HCD can potentially be incorporated into a simplified wound care regimen after excisional surgeries. Objective: To examine whether a one-time HCD application after dermatologic surgery results in greater patient satisfaction and improved postoperative outcomes compared with conventional daily dressings (CDD). Methods: We examined patients who underwent Mohs or standard surgical excision with linear closure followed by HCD. The patients additionally had a history of excisional surgery with CDD in the past 5 years. A modified version of the validated Bluebelle Wound Healing Questionnaire was administered. Results: The survey response rate was 74.4% (64/86). Compared with CDD, HCD rated higher in comfort, convenience, scar appearance, and simplicity of wound care instructions (P < .0001). Nearly all patients (96.8%) preferred HCD over CDD. Limitations: Variability in time from prior dermatologic surgery may introduce recall bias. Prior surgeries involving CDD were sometimes performed by a different surgeon, which could introduce other confounding factors. Conclusions: A simplified wound care regimen involving HCD can potentially lead to increased comfort, convenience, simplicity, and a subjective improvement in scar appearance, though additional studies are needed.