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    90-day Readmission Rates After Cholecystectomy: A Retrospective Cohort Study
    (Permanyer, 2022) Karabay, Önder; vd.
    Objective: Although readmission after surgical procedures has been recognized as a new problem, its association with cholecystectomy has not been solved. We aimed to investigate the rate of unplanned readmission after cholecystectomy and to evaluate the reasons and outcomes in these patients. Methods: All consecutive patients who underwent open and laparoscopic cholecystectomy were retrospectively evaluated. Hospital readmission within the post-operative first 90 days after the procedure was searched. The rate and reasons for hospital readmission were the primary outcomes. Results: There were 601 patients with a mean age of 53.2 ± 12.4 years. The rate of readmission was 6.16%. Obesity (p = 0.001), number of coexisting disease (p = 0.039), conversion to open surgery (p = 0.002), development of intraoperative complications (p < 0.001), use of drain (p = 0.001), and length of hospital stay > 1 day (p = 0.024) were significantly associated with higher readmission rates. Biliary surgical causes were detected in five patients (12.8%). Non-biliary surgical causes were seen in 34 patients (87.2%). Among these, post-operative pain, nausea, and vomiting were the most common diagnoses in 25 (67.6%) and 5 patients (12.8%). Conclusion: The readmission rate after cholecystectomy is low. Significant predictive factors may help physicians to be alerted during the discharge of the patients. Post-operative pain, nausea, and vomiting were the most common diagnoses.
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    Association of Preoperative Risk Factors and Mortality in Older Patients following Emergency Abdominal Surgery: A Retrospective Cohort Study
    (The Korean Geriatrics Society, 2021) Karabay, Önder; .;, ve diğer
    Background: Older patients undergoing emergency laparotomy have high morbidity and mortality rates. Preoperative risk assessment with good predictors is an appropriate measure in this population. Frailty status is significantly associated with postoperative outcomes in older adults. This study aimed to investigate the effect of preoperative risk factors and frailty on short-term outcomes following emergency surgery for acute abdomen in older patients. Methods: This study included older patients (?65 years of age) who underwent emergency abdominal surgery. We retrospectively analyzed their demographic and clinical variables and used the modified Frailty Index-11 to evaluate their frailty status. The primary outcome was the 30-day mortality rate. We also analyzed risk factors of mortality in these patients. Results: The study included 150 patients with a median age of 74 years. The mortality rate was 17.3% (n = 26). We observed significantly higher mortality rates in patients who were obese and who had higher American Society of Anesthesiology (ASA grades) (p < 0.05). The mortality rate was significantly higher in pre-frail and frail patients (p < 0.001). Septic shock was associated with the development of mortality (p < 0.001). Multivariate regression analysis revealed that ASA grade was the only independent risk factor for mortality (odds ratio [OR] = 19.642, 95% confidence interval [CI]: 3.886-99.274, p < 0.001). Conclusion: Older patients with obesity and frailty presenting with higher ASA grades and septic shock had the worst survival following emergency abdominal surgery. The ASA grade was an independent risk factor for mortality.
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    Impact of Ultrasonographic Features for Thyroid Malignancy in Patients With Bethesda Categories III, IV, and V: A Retrospective Observational Study in a Tertiary Center
    (Cureus, 2021) Karabay, Önder; Hacım, Nadir Adnan; Ülgen, Yiğit; Aktokmanyan, Talar Vartanoğlu; Meriç, Serhat; Altınel, Yüksel
    Introduction: Although fine-needle aspiration biopsy (FNAB) with cytologic interpretation using the Bethesda System for Reporting Thyroid Cytopathology has been widely used for thyroid nodules, its efficiency in Bethesda categories of III, IV, and V has been questioned due to variable risk of malignancy. We aimed to evaluate the impact of radiological parameters in Bethesda category III, IV, and V for thyroid malignancy. Methods: We performed a retrospective review of patients with Bethesda category III, IV, and V, and subsequent thyroidectomy. Demographic, ultrasonographic, and clinical variables were recorded. Independent variables for thyroid malignancy and the predictive power of imaging findings were analyzed. Results: There were 159 patients with a mean age of 48.1±13.4 years. Hypoechogenicity of the index nodule was the most common finding in 87 patients (54.7%). There were 74 (46.5%), 34 (21.4%), and 51 patients (32.1%) with Bethesda III, IV, and V categories, respectively. There were 91 patients (57.2%) with a diagnosis of thyroid malignancy. Overall malignant pathology was detected in 18 (24.3%), 25 (73.5%), and 48 patients (94.1%) in Bethesda III, IV, and V categories, respectively (p=0.001). The presence of solitary nodule, hypoechogenicity, and solid structure of index nodule and Bethesda category IV and V were significant variables for final malignant pathology (p<0.05 for all). Conclusion: Hypoechogenicity and solid structure in a solitary index nodule should be regarded as significant ultrasonographic findings for thyroid malignancy. Bethesda category IV and V were also significantly associated with malignanc