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Case Report
- Fatal Necrotizing Fasciitis Following Uncomplicated Colonoscopic Polypectomy: A Case Report
- Min Kyu Chae, Sang Youn Shin, Min Seob Kwak, Jin Young Yoon, Ha Il Kim, Jae Myung Cha
- Clin Endosc 2021;54(2):280-284. Published online December 11, 2020
- DOI: https://doi.org/10.5946/ce.2020.117
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Abstract
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ePub - Necrotizing fasciitis (NF) is a life-threatening infection that can be caused by various procedures or surgery and may develop in healthy elderly patients. Here, we report a case of a 66-year-old man with diabetes mellitus who underwent colonoscopic polypectomy, without complications. However, he visited the emergency department 24 hours after the procedure complaining of abdominal pain. Abdominopelvic computed tomography revealed multiple air bubbles in the right lateral abdominal muscles. After a diagnosis of NF was made, immediate surgical debridement was performed. However, despite three sessions of extensive surgical debridement and best supportive care at the intensive care unit, the patient died because of sepsis and NF-associated multiple-organ failure. In conclusion, physicians should pay special attention to the possibility of NF if a patient with risk factors for NF develops sepsis after colonoscopic polypectomy.
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Original Article
- A Nationwide Assessment of the “July Effect” and Predictors of Post-Endoscopic Retrograde Cholangiopancreatography Sepsis at Urban Teaching Hospitals in the United States
- Rupak Desai, Upenkumar Patel, Shreyans Doshi, Dipen Zalavadia, Wardah Siddiq, Hitanshu Dave, Mohammad Bilal, Vikas Khullar, Hemant Goyal, Madhav Desai, Nihar Shah
- Clin Endosc 2019;52(5):486-496. Published online May 27, 2019
- DOI: https://doi.org/10.5946/ce.2018.190
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Abstract
PDFPubReaderePub
- Background
/Aims: To analyze the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) sepsis in the early (July to September) and later (October to June) academic months to assess the “July effect”.
Methods
The National Inpatient Sample (2010–2014) was used to identify ERCP-related adult hospitalizations at urban teaching hospitals by applying relevant procedure codes from the International Classification of Diseases, 9th revision, Clinical Modification. Post-ERCP outcomes were compared between the early and later academic months. A multivariate analysis was performed to evaluate the odds of post-ERCP sepsis and its predictors.
Results
Of 481,193 ERCP procedures carried out at urban teaching hospitals, 124,934 were performed during the early academic months. The demographics were comparable for ERCP procedures performed during the early and later academic months. A higher incidence (9.4% vs. 8.8%, p<0.001) and odds (odds ratio [OR], 1.07) of post-ERCP sepsis were observed in ERCP performed during the early academic months. The in-hospital mortality rate (7% vs. 7.5%, p=0.072), length of stay, and total hospital charges in patients with post-ERCP sepsis were also equivalent between the 2 time points. Pre-ERCP cholangitis (OR, 3.20) and post-ERCP complications such as cholangitis (OR, 6.27), perforation (OR, 3.93), and hemorrhage (OR, 1.42) were significant predictors of higher post-ERCP sepsis in procedures performed during the early academic months.
Conclusions
The July effect was present in the incidence of post-ERCP sepsis, and academic programs should take into consideration the predictors of post-ERCP sepsis to lower health-care burden. -
Citations
Citations to this article as recorded by
- The July Effect on Mortality, Hospital Length of Stay, and Time to Colonoscopy Among Patients Presenting to Teaching Hospitals With LGIB in the United States
Eugene Annor, Chima Amadi, Joseph Atarere, Nneoma Ubah, Oluwatayo J. Awolumate, Adedeji Adenusi, Geraldine Nabiryo Nabeta, Darrell Downs, Ayokunle T. Abegunde
Journal of Clinical Gastroenterology.2025;[Epub] CrossRef - A Nationwide Study of the “July Effect” Concerning Postpartum Hemorrhage and Its Risk Factors at Teaching Hospitals across the United States
Zahra Shahin, Gulzar H. Shah, Bettye A. Apenteng, Kristie Waterfield, Hani Samawi
Healthcare.2023; 11(6): 788. CrossRef - July effect in clinical outcomes of esophagogastroduodenoscopy performed at teaching hospitals in the United States
Karthik Gangu, Sanket Basida, Rehmat Ullah Awan, Mohammad Ali Butt, Austin Reed, Rao Afzal, Rahul Shekhar, Harleen Kaur Chela, Ebubekir S. Daglilar, Abu Baker Sheikh
Baylor University Medical Center Proceedings.2023; 36(4): 478. CrossRef - Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?
Shyam Vedantam, Sunil Amin, Ben Maher, Saqib Ahmad, Shanil Kadir, Saad Khalid Niaz, Mark Wright, Nadeem Tehami
Clinical Endoscopy.2022; 55(3): 426. CrossRef - Post-ERCP Pancreatitis: Prevention, Diagnosis and Management
Oscar Cahyadi, Nadeem Tehami, Enrique de-Madaria, Keith Siau
Medicina.2022; 58(9): 1261. CrossRef - Risk factors for infections after endoscopic retrograde cholangiopancreatography (ERCP): a retrospective cohort analysis of US Medicare Fee-For-Service claims, 2015–2021
Susan Hutfless, Yasutoshi Shiratori, Daniel Chu, Simon Liu, Anthony Kalloo
BMJ Open.2022; 12(9): e065077. CrossRef - Clinical coaches and patient safety – Just in time: A descriptive exploratory study
Lorraine Thompson, Frances Lin, Annette Faithfull-Byrne, Judith Gonzalez, Amanda Naumann, Kathryn Geisler, Cheryle Moss
Nurse Education in Practice.2021; 54: 103134. CrossRef - Is the July Effect Real in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography?
Tae Yoon Lee, Yousuke Nakai
Clinical Endoscopy.2019; 52(5): 399. CrossRef
- The July Effect on Mortality, Hospital Length of Stay, and Time to Colonoscopy Among Patients Presenting to Teaching Hospitals With LGIB in the United States
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