Papers by Bhavin Vasavada
ABSTRACTAIMThe aim of our study was to evaluate the incidence and causative factors for acute kid... more ABSTRACTAIMThe aim of our study was to evaluate the incidence and causative factors for acute kidney injury in abdominal surgeries.Material and MethodsAll the abdominal surgeries performed between April 2018 to December 2020, in our institution have been analyzed for acute kidney injury. Acute kidney injury defined according to acute kidney injury network classification. Categorical variables were evaluated by chi-square t-test or fisher’s t-test wherever appropriate and continuous variables by Mann Whitney U test for nonparametric data and student t-test for parametric test after skewness and kurtosis analysis. Statistical analysis was done using SPSS version 23. P< 0.05 was considered statistically significant.ResultsWe performed 402 gastrointestinal and hepatobiliary surgery from April 2018 to December 2020. After exclusion 372 patients were included in the study population. 20 patients (5.37%) were defined as having acute kidney injury according to acute kidney injury network...
Aims: Primary AIM of the study was to evaluate effect of prolonged hospital stay on Surgical site... more Aims: Primary AIM of the study was to evaluate effect of prolonged hospital stay on Surgical site infections We also evaluated effect of prolonged hospital stay on overall morbidity in Gastrointestinal and Hepatobiliary Surgery as secondary outcome. Methods: We retrospectively analysed all the patients who underwent gastrointestinal and hepatobiliary surgery between April 2017 to March 2020. On our analysis we found mean hospital stay in patient who did not develop SSI and/or morbidity was 4 days (Total hospital stay) vs 6 days who developed morbidity (hospital stay before diagnosis of SSI or diagnosis or morbid event). Based on this to avoid selection bias, we did 1:1 propensity score analysis between patients who had 4 or less than hospital stay vs patients who had 5 or more hospital stay before diagnosis of surgical site infection and/or morbid event. We took all the preoperative and intraoperative factors like Age, sex, malignant disease, ASA score, CDC grade of surgery, open or...
International Journal of Celiac Disease, 2021
Introduction: There is an ongoing debate over the timings of laparoscopic cholecystectomy in acut... more Introduction: There is an ongoing debate over the timings of laparoscopic cholecystectomy in acute cholecystitis. Most authors recommend surgery within the first 72 hours. We offer laparoscopic cholecystectomies in every patient with acute cholecystitis regardless of the timing of presentation. Material and methods: We prospectively analyzed outcomes of our protocol of any time acute cholecystitis. We perform laparoscopic cholecystectomies within the first 24 hours of presentation to us without considering time since attack if the patient is not in septic shock where we follow survival sepsis guidelines. Results: We performed 110 laparoscopic cholecystectomies between April, 2019-March, 2020. We prefer single-dose preoperative antibiotics (third-generation cephalosporin) in all laparoscopic cholecystectomies. A total of 79 patients were having acute cholecystitis. 67 patients were having grade 2 and 12 patients were having grade 3 cholecystitis according to Tokyo guidelines. 50 patients were presented more than 72 hours after the attack. 21 patients presented more than 48 hours but less than 72 hours. 8 patients presented within 24 hours. The mean duration of the presentation was 120 hours. 5 patients presented after more than 7 days. One patient was having grade 3 cholecystitis and was having septic shock so he was managed with percutaneous cholecystostomy and according to survival sepsis, protocol and lap choly were done after 72 hours. Out of 79 patients included in the study, 2 patients were converted to open; in 3 patients we performed lap subtotal cholecystectomy due to difficult calot triangle. Out of these only 2 patients developed port site infection and 3 patients developed bilioma which was managed by percutaneous drainage. All patients were discharged the same day or the next day. Only two patients with bilioma were readmitted. Rest all of the patients had an uneventful recovery. Conclusion: There is no need to strictly follow the 72-hour time limit for laparoscopic cholecystectomy in acute cholecystitis. Any time laparoscopic cholecystectomy should be the rule inexperienced centre.
Aim: The aim of this systemic review and meta-analysis was to analyse 90 days mortality after liv... more Aim: The aim of this systemic review and meta-analysis was to analyse 90 days mortality after liver resection, and also study various factors associated with mortality via univariate and multivariate metaregression. Methods: PubMed, Cochrane library, Embase, google scholar, web of science with keywords like liver resection, mortalit, hepatectomy. Weighted percentage 90 days mortalities were analysed. univariate metaregression was done by DerSimonian-Liard methods. Major hepatectomy, open surgery, cirrhotic livers, blood loss, hepatectomy for hepatocellular carcinoma, hepatectomy for colorectal liver metastasis were taken as moderators in metaregression analysis. We decided to enter all co-variants in multivariate model to look for mixed effects. Heterogeneity was assessed using the Higgins I2 test, with values of 25%, 50% and 75% indicating low, moderate and high degrees of heterogeneity. Cohort studies were assessed for bias using the Newcastle-Ottawa Scale to assess for the risk o...
Indian Journal of Surgery
The aim was to do a retrospective analysis and audit of our 90-day and in-hospital mortalities af... more The aim was to do a retrospective analysis and audit of our 90-day and in-hospital mortalities after gastrointestinal and hepatopancreatic biliary surgeries performed in our department and analyze factors predicting them. All patients who underwent gastrointestinal and hepatopancreatic biliary surgery in our department in the last 3 years were evaluated for 90-day postoperative and in-hospital mortalities and various factors affecting them. Categorical values were analyzed using the chi-square test or Fisher’s exact test wherever appropriate. Continuous variables were analyzed using the Student t-test for parametric data and Mann–Whitney U test for nonparametric data after skewness and kurtosis analysis. Multivariate analysis was done using logistic regression analysis. A p-value less than 0.05 was considered statistically significant. Statistical analysis was done using SPSS version 23(IBM). Four hundred and twelve patients underwent gastrointestinal and hepatobiliary surgery in the last 3 years at our institute. Two hundred and twenty-two patients underwent major gastrointestinal and hepatobiliary surgeries in the last 3 years at our institute. Ninety-day all-cause mortality after major surgery was 10.8%, all-cause in-hospital mortality was around 8.5% in major surgery. Ninety-day mortality in elective and emergency surgeries was 6.7% and 22.4%, respectively. In-hospital mortality in elective and emergency surgeries was 4.8% and 18.9%, respectively. There was no 90-day mortality after nonmajor surgery. On multivariate analysis, nontechnical complications and emergency surgery independently predicted 90-day mortality. On multivariate analysis, acute kidney injury, nontechnical complications, and emergency surgeries independently predicted in-hospital mortalities. Nontechnical complications and emergency surgeries are independently associated with 90-day mortality, and acute kidney injury, nontechnical complications, and emergency surgery independently predict in-hospital mortality.
<sec> <title>UNSTRUCTURED</title> <p>All the gastrointestinal surgeries p... more <sec> <title>UNSTRUCTURED</title> <p>All the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. We performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79% . On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality There is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.</p> </sec>
Introduction: There is a controversy about the optimum timing of cholecystectomy after percutaneo... more Introduction: There is a controversy about the optimum timing of cholecystectomy after percutaneous cholecystostomy. This systematic review and meta-analysis aimed to evaluate outcomes of early versus late cholecystectomy after percutaneous cholecystectomy. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used. We evaluated cholecystectomy performed at different periods after percutaneous cholecystostomy within 72 hours or later, within or after one week or percutaneous cholecystostomy, within 10 days or after 10 days, less than 2 weeks or more than 2 weeks, less than 4 weeks or more than 4 weeks, less than 8 weeks or more than 8 weeks as per literature. Results: Six studies including 18640 patients were included in the final analysis. There was no difference in overall complications with...
Aim of study: Aim of this meta-analysis is to evaluate post-operative procalcitonin as a marker t... more Aim of study: Aim of this meta-analysis is to evaluate post-operative procalcitonin as a marker to predict post- operative infectious complications after pancreatic surgeries. Material and Methods: Systemic literature search was performed using MEDLINE, EMBASE and to identify studies evaluating the diagnostic accuracy of Procalcitonin (PCT) as a predictor for detecting infectious complications on postoperative days (POD) 3 and 5 following pancreatic surgery. A meta-analysis was performed using random effect model and pooled predictive parameters for POD 3 and 5 were derived. Geometric means were calculated for PCT cut offs. Results: 6 studies included day 3 PCT analysis, 2 studies included both day 3 and day 5 analysis. Total data of 471 patients were derived. 161 patients developed infectious complications. Pooled sensitivity, specificity, pooled area under curve, diagnostic odds ratio (DOR), positive and negative like hood ratio of day 3 PCT were 74%,79%,0.8453, 11.03,3.17 and 0.3...
AimThis systematic review and meta-analysis aimed to study the incidence of acute kidney injury a... more AimThis systematic review and meta-analysis aimed to study the incidence of acute kidney injury after liver resection and to analyze various factors affecting it by metaregression analysis.MethodsThe study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (2020) and MOOSE guidelines. The meta-analysis was done using Review Manager 5.4 and the JASP Team (2020). JASP (Version 0.14.1)(University of Amsterdam). Weighted percentage incidence with 95% confidence intervals were used. Univariate metaregression was done by DerSimonian-Laird methods. Factors with a p-value less than 0.05 in the univariate metaregression model were entered in the multivariate metaregression model. Heterogeneity was assessed using the Higgins I2 test. The random-effects model was used in meta-analysis.ResultsTotal 14 studies including 15510 patients were included in the final analysis. 1247 patients developed Acute Kidney Injury. Weighted Acute ...
British Journal of Surgery
ANZ Journal of Surgery
Aim of this meta‐analysis was to compare diagnostic accuracy C‐reactive protein and procalcitonin... more Aim of this meta‐analysis was to compare diagnostic accuracy C‐reactive protein and procalcitonin between postoperative days 3 and 5 to predict infectious complications post pancreatic surgery.
Aim of the study: This systematic review and meta-analysis aimed to analyse post-operative morbid... more Aim of the study: This systematic review and meta-analysis aimed to analyse post-operative morbidity after liver resection, and also study various factors associated with mortality via metaregression analysis.Material and Methods: PubMed, Cochrane Library, Embase, google scholar, web of science with keywords like ‘liver resection”; ”mortality”;” hepatectomy”. Weighted percentage post-operative morbidities were analysed. Meta-analysis and meta-regression were done by the DerSimonian-Liard random effect model. Heterogeneity was assessed using the Higgins I2 test. Publication bias was assessed using a funnel plot. Funnel plot asymmetry was evaluated by Egger’s test. Morbidity was defined as any postoperative morbidity mentioned.Results: A total of 46 studies was included in the final analysis. Total 45771 patients underwent liver resections. 16111 patients experienced complications during the postoperative period. Weighted post-operative morbidity was 30.2% ( 95 % C.I. 24.8-35.7%). Het...
BackgroundWe evaluated our protocol of extrafascial transfissural approach for liver resection wi... more BackgroundWe evaluated our protocol of extrafascial transfissural approach for liver resection with intrafascial approach that we use in case of donor hepatectomy.Material and MethodWe use extrafascial transfissural approach with finger fracture technique for liver resections and inftrafascial approach with clamp crush technique in case of donor hepatectomy. Major hepatectomy defined as resection of 2 or more adjacent segments.We compared these two techniques with regard to blood loss, operative time, morbidity and mortality.We also evaluated over all factors responsible for 90 days mortality.statistical analysis was done using SPSS version 23.(IBM).Categorical factors were evaluated using chi square test and numerical factors were analyzed using Mann Whitney U test. Multivariate analysis was done using logisitic regression method. Ethical approval for our clinical study was obtained by human research COA number SBI 3246.ResultsWe evaluated 26 liver resections done in last three yea...
Aim of study:Aim of this meta-analysis is to evaluate post-operative procalcitonin as a marker to... more Aim of study:Aim of this meta-analysis is to evaluate post-operative procalcitonin as a marker to predict post- operative infectious complications after pancreatic surgeries.Material and Methods:Systemic literature search was performed using MEDLINE, EMBASE and to identify studies evaluating the diagnostic accuracy of Procalcitonin (PCT) as a predictor for detecting infectious complications on postoperative days (POD) 3 and 5 following pancreatic surgery. A meta-analysis was performed using random effect model and pooled predictive parameters for POD 3 and 5 were derived. Geometric means were calculated for PCT cut offs. Results:6 studies included day 3 PCT analysis, 2 studies included both day 3 and day 5 analysis. Total data of 471 patients were derived. 161 patients developed infectious complications. Pooled sensitivity, specificity, pooled area under curve, diagnostic odds ratio (DOR), positive and negative like hood ratio of day 3 PCT were 74%,79%,0.8453, 11.03,3.17 and 0.31 re...
Aim of study:Aim of this meta-analysis is to evaluate post-operative procalcitonin as a marker to... more Aim of study:Aim of this meta-analysis is to evaluate post-operative procalcitonin as a marker to predict post- operative infectious complications after pancreatic surgeries.Material and Methods:Systemic literature search was performed using MEDLINE, EMBASE and to identify studies evaluating the diagnostic accuracy of Procalcitonin (PCT) as a predictor for detecting infectious complications on postoperative days (POD) 3 and 5 following pancreatic surgery. A meta-analysis was performed using random effect model and pooled predictive parameters for POD 3 and 5 were derived. Geometric means were calculated for PCT cut offs. Results:6 studies included day 3 PCT analysis, 2 studies included both day 3 and day 5 analysis. Total data of 471 patients were derived. 161 patients developed infectious complications. Pooled sensitivity, specificity, pooled area under curve, diagnostic odds ratio (DOR), positive and negative like hood ratio of day 3 PCT were 74%,79%,0.8453, 11.03,3.17 and 0.31 re...
ABSTRACTIntroductionThe aim of this study is to compare 90-day mortality and morbidity between op... more ABSTRACTIntroductionThe aim of this study is to compare 90-day mortality and morbidity between open and laparoscopic surgeries performed in one centre since the introduction of ERAS protocols.Material and MethodsAll gastrointestinal surgeries performed between April 2016 and March 2019 at our institution after the introduction of ERAS protocols have been analysed for morbidity and mortality. The analysis was performed in a retrospective manner using data from our prospectively maintained database.ResultsWe performed 245 gastrointestinal and hepatobiliary surgeries between April 2016 and March 2019. The mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. The mean ASA score was 2.4, the mean operative time was 111 minutes and the mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall the 90-day mortality rate was 8.5% and the morbidity rate was around 9.79%. On univariate analysis morbidity was associated with a higher CDC grade of surgeries, a higher ASA grade, longer operating time, the use of more blood products, a longer hospital stay and open surgeries. HPB surgeries and luminal surgeries (non hpb gastrointestinal surgeries) were associated with 90 day post operative morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90-day mortality was predicted by the grade of surgeries, a higher ASA grade, longer operative time, the use of more blood products, open surgeries and emergency surgeries. However on multivariate analysis only the use of more blood products was independently associated with mortalityConclusionThe 90-day mortality and morbidity rates between open and laparoscopic surgeries after the introduction of ERAS protocol were similar.
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Papers by Bhavin Vasavada