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J J Millili

Publications and source records attributed to J J Millili.

6 recordsLinked to original sources
PubMed1998

Predicting surgical outcome using Bayesian analysis.

Surgical outcome analysis is best performed using Bayesian statistics. The ability of this type of analysis to take into consideration multiple parameters affecting surgical outcome is a marked improvement over single-condition probabilities that ignore the many degrees of freedom in the dynamics of a surgical intervention. To illustrate the power of a Bayesian analysis a surgical population of 1017 patients undergoing cholecystectomy, colon resection, and appendectomy was developed. Each patient was assigned to a mutually exclusive outcome group (D1, survival; D2, survival with complications; D3, nonsurvival). A priori outcome probabilities for the population were D1 = 0.917, D2 = 0.066, and D3 = 0.017. A conditional probability matrix (CPM) was then developed for 59 patient parameters (Sj) that may have affected outcome. The CPM contained the conditional probability that a parameter was present given the known outcome P(Sj/Di). Once the CPM was matured Bayesian analysis allowed one to predict the surgical outcome given any set or combination of patient parameters P(Di/Sj). Posterior probabilities generated by the Bayes analysis allowed one to investigate the effect of a single parameter or any group of parameters on outcome. Criterion based validity testing based on comparison of Bayesian outcomes versus the surgeons perception of outcomes for computer simulated surgery on 15 artificial patients suggests that this type of analysis provides insightful and educational data to the operating surgeons (V-mortality = 0.547, SEE = 24.46; V-morbidity = 0.319, SEE = 25.86). Objective outcome analysis or surgical peer review cannot be fairly accomplished unless the statistical methodology takes into consideration all of the parameters affecting outcome. This study concludes that Bayes Theorem provides the ideal statistical framework for performing an outcome analysis that considers the many parameters affecting the results of a surgical intervention.

Adolescent↗
PubMed1985

Management of acute postoperative thrombosis following carotid endarterectomy.

We reviewed 326 carotid endarterectomies performed from 1960 through 1981 and encountered five instances of acute postoperative thrombosis. Clinical decompensation occurs with the acute onset of severe neurologic deficits, most characteristically dense hemiplegias contralateral to the side that has been operated on. These deficits developed between two and 72 hours postoperatively. Prompt reoperation with thrombectomy and reestablishment of carotid flow within two hours from the onset of the neurologic deficit was performed on four patients with complete resolution of the deficits in three patients. The fourth patient recovered from a severe hemiplegia but retained a slight residual weakness of the hand. The one patient whose condition did not improve underwent thrombectomy more than 24 hours after the onset of her deficit. Time-consuming diagnostic procedures are not warranted as the success of reoperation depends on rapid reestablishment of cerebral flow.

Acute Disease↗
PubMed1981

Leiomyosarcoma of the abdominal aorta: a case report.

A case report of a leiomyosarcoma of the abdominal aorta is presented. The patient was referred to our institution because of symptoms of an acute occlusion of the infrarenal aorta. En bloc resection of the tumor and reconstruction of distal arterial flow were performed.

Aorta, Abdominal↗
PubMed1980

A study of anastomotic aneurysms following aortofemoral prosthetic bypass.

Between 1960--1979, 19 patients with aortofemoral prosthetic bypass for aneurysmal and/or occlusive disease subsequently developed 36 false aneurysms at the suture line, for an incidence of 4.5% (19/426 patients). The two major aneurysm sites were the femoral anastomosis 4.5% (33/727) patients), and the aortic anastomosis 0.7% (3/430 patients). Additionally, one patient with bilateral false aneurysms of the groin subsequently developed an aortoduodenal fistula. The initial operation was for aortoiliac occlusive disease in 14 and for abdominal aortic aneurysms plus severe occlusive disease in five. The false aneurysm(s) appeared three months to 17 years after the aortofemoral procedure. Eleven of 19 patients (57.9%) had multiple aneurysms (two to five) and developed both right and left groin aneurysms concomitantly or at different times. Suture failure was the major finding at operation. However, a common alternative finding was partial or near complete separation of the prosthesis from the host vessel and an intact suture line, thus indicating a structural weakness in the host vessel and/or severe mechanical stress, as the causative factor. One experience leads us to favor an aggressive surgical approach to these lesions. All false aneurysms were corrected as they were detected with good surgical results.

Adult↗