The current project was done without financial support. All funding received by COPSAC is listed on www.copsac.com.
Background: Long-term follow-up studies establishing risk factors for loss of asthma control in well-controlled children with mild to moderate disease are lacking and are of importance for improving patient quality of life and utilization of health-care resources.Methods: Loss of asthma control was assessed in 146 school-aged children with well-controlled mild to moderate asthma from a Danish pediatric asthma outpatient clinic based on hospital admissions, emergency department (ED), or outpatient management of exacerbations, oral corticosteroid (OCS) use, or step-up of regular asthma treatment according to Global Initiative for Asthma (GINA) guidelines through a 5-year follow-up period. Risk factors included sex, ethnicity, age, body mass index (BMI), atopic comorbidity and predisposition, lung function, fractional exhaled nitric oxide (FeNO) level, exercise challenge test results, regular physical activity, GINA treatment step at baseline, and adherence to controller therapy.Results: A total of 27 (18%) children experienced 56 acute events defined by hospital admission, ED, or outpatient management. Risk of experiencing any acute event was increased with female sex (adjusted odds ratio, aOR = 2.4 (1.0-5.9), p = 0.047) and higher baseline GINA treatment step (aOR = 1.6 (1.1-2.5), p = 0.03). Furthermore, female sex (aOR = 6.1 (1.4-42.2), p = 0.01) and higher FeNO (aOR = 1.8(1.0-3.2), p = 0.04) were associated with OCS prescriptions, whereas no risk factors were identified for GINA treatment step-up during the 5-year follow-up.Conclusions: Female sex, higher FeNO, and higher baseline GINA treatment step increase the risk of long-term loss of control including acute events and OCS use in well-controlled children with mild to moderate asthma. These findings are important for primary physicians and clinicians in asthma outpatient clinics to identify seemingly well-controlled children at risk to plan more frequent follow-ups.
Aim The role of a robot-assisted approach in hernia surgery remains controversial due to the high costs associated with robotic surgery and the proposed equal outcomes compared to open surgery. In the current study, we report the 30-day results of the introduction of robot-assisted approach in a dedicated regional ventral hernia repair center. Material & Methods This was a retrospective single-center cohort study, including consecutive patients undergoing ventral hernia repair from 2017 to 2022. To reduce the risk of bias, patients undergoing robotic and open repair were matched by propensity scores in a 1:2 ratio on the variables age, type of hernia (primary/ventral) and horizontal fascial defect size. Multivariable logistic regression was performed. Results A total of 109 patients undergoing robotic repair were compared to 231 undergoing open repair, of which 61.2% were incisional and 38.8% primary hernias. Mean hernia defect size was 4.9×6.5 cm (horizontal x vertical). The mean length of stay was lower after robotic repair (0.1 vs. 1.9 days, P < 0.001) as was the incidence of readmission (3.7% vs. 15.2%, P < 0.001). The incidence of reoperation was insignificantly lower after robotic repair (0.9% vs. 4.8%, P = 0.139), however after adjusting for confounders there was a significantly reduced risk of reoperation after robotic compared to open repair (OR 0.08, CI 0.01–0.92, P = 0.043). Conclusions The introduction of a robotic approach was associated with significantly improved postoperative outcomes.
Aim Enhanced recovery after surgery (ERAS) protocols lead to reduced postoperative stay and improved outcomes after most types of abdominal surgery. Little is known about the optimal postoperative protocol after robotic ventral hernia repair (RVHR), including the potential limits of outpatient surgery. We report the results of an ERAS protocol after RVHR aiming to identify predictors of overnight stay in-hospital, as well as patient-reported pain levels in the immediate postoperative period. Material & Methods This was a prospective cohort study of consecutive patients undergoing RVHR. Patients were included in a prospective database, registering patient characteristics, operative details, pain and fatigue during the first three postoperative days and pre- and 30-day postoperative hernia-related quality of life, using the EURA-HS questionnaire. Results A total of 109 patients were included, of which 66 (61%) underwent incisional hernia repair. The most performed procedure was TARUP (Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair) (60.6%) followed by bilateral roboTAR (robotic Transversus Abdominis Release) (19.3%). The mean horizontal fascial defect was 4.8 cm and the mean duration of surgery was 141 minutes. In total, 78 (71.6%) patients were discharged on the day of surgery, and confounders associated with overnight stay were increasing fascial defect area, duration of surgery, and addition of TAR. There was no association between postoperative pain and overnight hospital stay. The mean EuraHS score decreased significantly from 38.4 to 6.4 (P < 0.001). Conclusions The application of an ERAS protocol after RVHR enabled a high rate of outpatient procedures with low patient-reported pain scores.
Asthma is one of the most common chronic diseases in children globally. Previous studies have shown that not attending asthma primary care consultations is associated with poorer treatment adherence and increased risk of loss of asthma control on a short-term basis. Here, we investigated long-term patterns and predictors of not attending scheduled asthma outpatient visits during 5-years of follow-up in 146 children with asthma. Of the 146 children, 67 (46%) did not attend at least one scheduled appointment, amounting to a total of 122 (10.8%) missed of 1133 scheduled appointments. In a multivariate analysis adjusting for total scheduled visits in the 5-year period any allergic sensitization was a significant risk factor for not attending ≥1 scheduled appointment (aOR = 6.6 (95% CI, 1.3–39.7), p = 0.03), which was not the case for asthma treatment step or lung function. Furthermore, atopic predisposition decreased the risk of non-attendance (aOR = 0.36 (0.13–0.92), p = 0.04). We found no association between non-attendance, treatment adherence or loss of asthma control. This study highlights that allergic comorbidity, but not degree of asthma severity, identifies a group of children with asthma who are prone to not attend scheduled outpatient appointments.
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