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Karem Slim

Publications and source records attributed to Karem Slim.

At least 19 recordsLinked to original sources
PubMed2006

Predicting postoperative mortality in patients undergoing colorectal surgery.

Well-known and suitable instruments for surgical audit are the POSSUM and P-POSSUM scoring systems. But these scores have not been well validated across the countries. The objective of the present study was to assess the predictive value of scores for colorectal surgery in France. Patients operated on for colorectal malignant or diverticular diseases, whether electively or on emergency basis, within a 4-month period were included in a prospective multicenter study conducted by the French Association for Surgery (Association Française de Chirurgie, AFC). The main outcome measure was postoperative in-hospital mortality. Independent factors leading to death were assessed by multivariate logistic regression analysis (AFC-index). The ratio of expected versus observed deaths was calculated, and the predictive value of the POSSUM and P-POSSUM scores were analyzed by the receiver operating characteristic (ROC) curve. A total of 1426 patients were included. The in-hospital death rate was 3.4%. Four independent preoperative factors (AFC-index) have been found: emergency surgery, loss of more than 10% of weight, neurological disease history, and age > 70 years. POSSUM had a poor predictive value; it overestimated postoperative death in all cases. P-POSSUM had a good predictive value, except for elective surgery, where it overestimated postoperative death twofold. The predictive value of the AFC-index was also good. It had the same sensitivity and specificity as the P-POSSUM. POSSUM has not been validated in France in the field of colorectal surgery. P-POSSUM was as predictive as the AFC-index which is a simpler instrument based on four clinical parameters (without any mathematical formulas).

Aged↗
PubMed2006

Tobacco smoking: a factor of early onset of colorectal cancer.

PURPOSE: Tobacco smoking is associated with a higher risk of developing colorectal cancer. This study was designed to assess the role of smoking in early onset of colorectal pathology. METHODS: This was a prospective cross-sectional study of 997 patients with colorectal cancer. Age of colorectal cancer diagnosis was studied in two groups of patients, i.e., smokers (>10 pack-years) and nonsmokers. Confounding factors, such as alcohol drinking, obesity, and gender, also were studied using a correlation analysis and multivariate logistic regression analysis. RESULTS: Of the 997 patients, 852 had sufficient data for analysis and were included. Baseline analysis showed that excluded patients had similar demographic characteristics. Smokers (n=108) reported symptoms related to colorectal cancer at an earlier mean age (64.1 (standard deviation, 11.7) years) than nonsmokers (69.6 (standard deviation, 12.6) years; mean difference, 5.5 (standard deviation, 1.2 years); P<0.001). Impact of smoking according to the bowel segment involved was significant for slow-transit segments (transverse and sigmoid colon and rectum). Multivariate analysis revealed that tobacco smoking was the only independent risk factor of early onset of colorectal cancers. CONCLUSIONS: Tobacco smoking could be a factor of early onset of colorectal cancers especially for slow-transit bowel segments. If these findings are confirmed in larger studies, screening for colorectal cancer should not involve a simple sigmoidoscopy but also an exploration of transverse colon in smokers.

Age of Onset↗
PubMed2005

Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study.

HYPOTHESIS: Better knowledge of independent risk factors might decrease mortality and morbidity rates following colorectal surgery. DESIGN: Prospective multicenter study. INTERVENTIONS: From June to September 2002, consecutive patients undergoing open or laparoscopic surgery (electively or on an emergent basis) for colorectal cancers or diverticular disease were prospectively included. Exclusion criteria were colectomy for other causes (eg, inflammatory bowel diseases, benign polyps). The structured sheet of data collection included more than 200 items on all perioperative data concerning the patient, the disease, and the operating surgeons. Postoperative mortality and morbidity were defined as in-hospital death and complications. RESULTS: Among 1421 patients, the in-hospital death rate was 3.4% and the overall morbidity rate was 35%. Four independent preoperative risk factors of mortality were found: emergency surgery, loss of more than 10% of weight, neurological comorbidity, and age older than 70 years. Six independent risk factors of morbidity were found: age older than 70 years, neurologic comorbidity, hypoalbuminemia, cardiorespiratory comorbidity, long duration of operation, and peritoneal contamination. CONCLUSION: Colorectal resection in France is associated with a 3.4% mortality rate and a 35% morbidity rate. Knowledge of the risk factors could help surgeons manage cases.

Age Factors↗
PubMed2005

Limits of evidence-based surgery.

Evidence-based medicine can be summarized as the use of current best evidence in the care of individual patients. When applied to surgical practice, it appears clearly that the concept of evidence-based medicine involves some limitations. To discuss these limits, the author went back over the terms of the evidence-based medicine definition. Limits are related to the low quantity and quality of randomized controlled trials and meta-analyses in surgery, the difficulties when critically appraising the literature and applying the results of evidence to individual patients, and bringing surgeons more willing to endorse the principles of evidence-based medicine. However all these limits can be overcome in the future, with the aim that evidence-based surgery will not be a passing fad.

Decision Making↗
PubMed2005

Reflux, dysphagia, and gas bloat after laparoscopic fundoplication in patients with incidentally discovered hiatal hernia and in a control group.

BACKGROUND: Laparoscopic fundoplication effectively controls reflux symptoms in patients with gastroesophageal reflux disease (GERD). However, symptom relapse and side effects, including dysphagia and gas bloat, may develop after surgery. The aim of the study was to assess these symptoms in patients who underwent laparoscopic fundoplication, as well as in control subjects and patients with hiatal hernia. METHODS: A standardized, validated questionnaire on reflux, dysphagia, and gas bloat was filled out by 115 patients with a follow-up of 1 to 7 years after laparoscopic fundoplication, as well as by 105 subjects with an incidentally discovered hiatal hernia and 238 control subjects. RESULTS: Patients who underwent fundoplication had better reflux scores than patients with hiatal hernia ( P = .0001) and similar scores to control subjects ( P = .11). They also had significantly more dysphagia and gas bloat than patients with hiatal hernia and controls ( P < .005 for all comparisons). Gas bloat and dysphagia were more severe in hiatal hernia patients than in controls ( P < 0.005). After fundoplication, the 25% of the patients with the shortest follow-up (1.5 +/- 0.2 years) and the 25% patients with the longest follow-up (5.8 +/- 0.6 years) had similar reflux, dysphagia, and gas bloat scores ( P = .43, .82, and .85, respectively). CONCLUSION: In patients with severe GERD, laparoscopic fundoplication decreases reflux symptoms to levels found in control subjects. These results appear to be stable over time. However, patients who underwent fundoplication experience more dysphagia and gas bloat than controls and patients with hiatal hernia-symptoms that should be seen as a side effect of the procedure and of GERD itself.

Adult↗
PubMed2005

Mortality and morbidity after surgery of mid and low rectal cancer. Results of a French prospective multicentric study.

BACKGROUND: The aim of the study was to assess both mortality and morbidity following resection of mid and low rectal cancers in a French prospective multicentric study. PATIENTS: From June to September 2002, consecutive patients undergoing resection for cancer of the mid- or lower rectum were prospectively included in a multicentric study. Both postoperative mortality and morbidity were recorded. Multivariate statistical analysis was performed in order to assess risk factors predictive of postoperative morbidity. RESULTS: 238 patients with a mean age of 66 +/- 13 years (range: 26-88) were included. Neoadjuvant radiotherapy was performed in 68% of the patients. Total mesorectal excision was performed in 218 patients (92%), of whom 151 (63%) had a sphincter saving procedure. Six patients died (2.5%). Overall postoperative morbidity rate was 43%, including anastomotic leakage (11%) and reoperation (5%). Mean hospital-in-stay was 20 +/- 16 days (range: 3191). Four independent risk factors of morbidity were found: perioperative fecal contamination (OR = 3.9 [1.1; 13.5]), mean operating time longer than 6 hours (OR = 4.5 [1.7; 12.1]), ASA score > 2 (OR = 3.2 [1.6; 7.9]), and smocking (OR = 3.3 [1.2; 8.9]). CONCLUSIONS: Resection of cancer involving the middle or lower rectum with sphincter saving procedures was possible in two-thirds of the patients and was associated with 2.5% mortality and 43% morbidity.

Aged↗
PubMed2003

[Medicine should be evidence-based, surgery too].

UNLABELLED: SURGERY TOO: The concept of evidence-based medicine, in vogue for several years, must also apply to surgery, even if the latter has specific characteristics. ADVANTAGES OF EVIDENCE-BASED SURGERY: The advantages are related to the expansion of surgeons' critical eye and their questioning of the scientifically unfounded dogmas. CONSTRAINTS OF EVIDENCE-BASED SURGERY: The constraints are not only basically material with the need to have access to data banks, which often costs money, but also methodological with the need to assess the scientific quality of the articles found in the literature. LIMITS OF EVIDENCE-BASED SURGERY: These are related to the rarity of randomized trials and meta-analyses in the surgical literature and therefore, regarding surgery as opposed to other medical domains, to the reduced level of evidence. Hence,to develop good quality, so-called "pragmatic" and prospective trials is needed. DANGERS OF EVIDENCE-BASED SURGERY: The greatest danger is the fact that the evidence-based approach is either misunderstood or misconstrued, particularly since it integrates in the scientific data the surgeons' decision, the clinical context or even the patients' preference. CONCLUSION: Evidence-based surgery is not a fleeting fancy. Today, it is a well-established fact, the aim of which is to treat the patients according to the most fitting scientific data.

Databases as Topic↗
PubMed2003

Methodological index for non-randomized studies (minors): development and validation of a new instrument.

BACKGROUND: Because of specific methodological difficulties in conducting randomized trials, surgical research remains dependent predominantly on observational or non-randomized studies. Few validated instruments are available to determine the methodological quality of such studies either from the reader's perspective or for the purpose of meta-analysis. The aim of the present study was to develop and validate such an instrument. METHODS: After an initial conceptualization phase of a methodological index for non-randomized studies (MINORS), a list of 12 potential items was sent to 100 experts from different surgical specialties for evaluation and was also assessed by 10 clinical methodologists. Subsequent testing involved the assessment of inter-reviewer agreement, test-retest reliability at 2 months, internal consistency reliability and external validity. RESULTS: The final version of MINORS contained 12 items, the first eight being specifically for non-comparative studies. Reliability was established on the basis of good inter-reviewer agreement, high test-retest reliability by the kappa-coefficient and good internal consistency by a high Cronbach's alpha-coefficient. External validity was established in terms of the ability of MINORS to identify excellent trials. CONCLUSIONS: MINORS is a valid instrument designed to assess the methodological quality of non-randomized surgical studies, whether comparative or non-comparative. The next step will be to determine its external validity when used in a large number of studies and to compare it with other existing instruments.

Clinical Trials as Topic↗