Konstantinos Balalis

Bio: Konstantinos Balalis is an academic researcher from University of Crete. The author has contributed to research in topics: Retrospective cohort study & Clopidogrel. The author has an hindex of 4, co-authored 4 publications receiving 67 citations.

Is the ASA Score in Geriatric Hip Fractures a Predictive Factor for Complications and Readmission

Abstract: Hip fractures are the second cause of hospitalization in geriatric patients. The American Society of Anesthesiologists (ASA) classification scheme is a scoring system for the evaluation of the patients' health and comorbidities before an operative procedure. The purpose of this study was to determine whether the ASA score is a predictive factor for perioperative and postoperative complications and a cause of readmission of geriatric patients with hip fractures. The study included 198 elderly patients. The mean values of hospitalization were 6.4 ± 2.1 days for the patients with ASA II, 10.4 ± 3.4 days for the patients with ASA III, and 13.5 ± 4.4 days for the patients with ASA IV. The patients with ASA II exhibited minor complications, while patients with ASA III presented cutaneous ulcer and respiratory dysfunction. Five patients with ASA IV had pulmonary embolism, two patients had myocardial infarction, and three patients died. The ASA score seems to have direct correlation with multiple factors, such as the hospitalization days, the severity of the complications, and the total hospitalization costs. The treatment of geriatrics hip fractures in patients with a high ASA score requires a multidisciplinary approach and a special assessment in order to decrease postoperative morbidity and mortality and offer optimal functionality.

Giant cell tumors of the tendon sheath of the hand: an 11-year retrospective study.

Abstract: Purpose: Giant cell tumor of the tendon sheath (GCTTS) is a slowly progressing soft tissue tumor. The present retrospective study recorded and evaluated cases of GCTTS of the hand. Methods: A cohort of patients suffering from GCTTS of the hand and treated surgically were studied in terms of diagnosis, therapy, recurrence, as well as in terms of functional outcome with the use of the QuickDASH score. Results: A total of 36 patients (13 men; 23 women) with a mean age of 38.8 years (±standard deviation;SD=8.7) were evaluated. According to Al-Qattan classification 10 cases of type Ia, 11 cases of type Ib, 6 cases of Ic and 9 cases of IIa were found, while the mean tumor diameter was 2.6 cm (SD=1.1). The mean follow up was 21 months (SD=12). The mean QuickDASH Score was 6.3 (SD=6.7). Furthermore, a total of 31 patients (86%) characterized their outcome as satisfactory. Recurrence was observed in 4 patients, while none of them had initially undergone radiotherapy. Conclusions: This study has shown a direct correlation between the QuickDASH Score results and the objective level of satisfaction in cases of GCTTS treated surgically. The present study cohort had 11.11% recurrence rate during a mean follow-up of 21 months. It is of note that none of these cases had initially undergone radiotherapy. It is of utmost importance to carefully select the patients that meet the criteria for postoperative radiotherapy.

Heparin resistance and coagulation activation rebound effect after anticoagulant withdrawal: beneficiary effect of adjuvant antiplatelet therapy

Abstract: Background Aim. The aim of this study was to investigate biological resistance to enoxaparin and rebound effect after prophylaxis withdrawal, using thrombin generation (TG) assay. Methods Fifteen-patients undergoing femoro-popliteal bypass grafting (enoxaparin 4000 antiXaIU+75 mg clopidogrel), and 15-patients undergoing total-hip-replacement (THR) (enoxaparin alone). TG-assay parameters (lag-time, endogenous-thrombin-potential, peak-, time-to-peak, and Mean-Rate-Index) were assessed to investigate heparin resistance and rebound effect after prophylaxis interruption. Measurements were obtained preoperative, postoperative (before prophylaxis initiation), 8-days postoperative, and 48-hours after anticoagulant withdrawal (day 32). Results Surgery increased TG in vascular-patients despite intra-operative unfractioned heparin administration when compared to orthopedic patients (MRI:P=0.039, ETP:P=0.001, PGT:P=0.003), but this perioperative prothrombotic status was reversed by postoperative thromboprophylaxis. No thromboembolic events were observed. Similar TG parameter values between the 8th and 32nd postoperative day indicate that vascular patients were adequately protected after prophylaxis withdrawal, probably due to the synergic action of clopidogrel, while orthopedic patients increased TG on day-32 compared to the 8th postoperative day (P=0.03, for both lag-time and ttPeak). Furthermore, on day-32, a prothrombotic status (increased TG) was observed in the orthopedic patients (P=0.034, and 0.004 for ttPeak and lag-time, respectively). Inter-individual variability to enoxaparin response was observed in both groups:7/15 vascular and 10/15 orthopedic patients increased TG despite anticoagulant administration, which reveals heparin-resistance. Among the heparin-resistant patients, 4 vascular and 6 orthopedic increased TG after anticoagulant withdrawal, depicting a rebound effect to activation of coagulation. Conclusions Heparin-resistance is not a rare phenomenon in clinical practice and was found in about half of our patients. A rebound effect of coagulation activation after thromboprophylaxis withdrawal is observed in the extended postoperative period. This phenomenon is attenuated with the addition of concomitant antiplatelet (clopidogrel) treatment.

Femoral 3-in-1 Nerve Block for Total Knee Replacement, an Analgesic Approach Not to Be Neglected. Single Center Experience and Literature Review

Abstract: Objectives. Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In this retrospective observational study, we evaluated the effectiveness of 3-in-1 nerve block in patients after total knee arthroplasty compared to standard opioid treatment, and we state the reasons why this approach should still be considered. Methods. To evaluate the effectiveness of the 3-in-1 nerve block, we assessed the acute pain service archive and compared the values of the visual analog scale, by separating patients into two groups according to the analgesic regimen they received as per local protocols. In group A, patients received 0.25% bupivacaine through a 3 in 1 block catheter and additional meperidine IM if needed, while in group B they received meperidine every six hours. Results. Our analysis showed the statistically significant better effectiveness of 3-in-1 nerve block with bupivacaine administration in postoperative TKR pain control compared to repeated administration of meperidine. Conclusion. The results of our study suggest that 3-in-1 nerve block with bupivacaine is an option that must always be considered in order to alleviate post-operative pain after TKR.

Monitoring low molecular weight heparins at therapeutic levels: dose-responses of, and correlations and differences between aPTT, anti-factor Xa and thrombin generation assays.

Abstract: Low molecular weight heparins (LMWH's) are used to prevent and treat thrombosis. Tests for monitoring LMWH's include anti-factor Xa (anti-FXa), activated partial thromboplastin time (aPTT) and thrombin generation. Anti-FXa is the current gold standard despite LMWH's varying affinities for FXa and thrombin.

An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020

Abstract: Patients undergoing total hip and knee arthroplasty are at high risk for venous thromboembolism (VTE) with an incidence of approximately 06–15% Given the high volume of these operations, with approximately one million performed annually in the US, the rate of VTE represents a large absolute number of patients The rate of VTE after total hip arthroplasty has been stable over the past decade, although there has been a slight reduction in the rate of deep venous thrombosis (DVT), but not pulmonary embolism (PE), after total knee arthroplasty Over this time, there has been significant research into the optimal choice of pharmacologic VTE prophylaxis for individual patients, with the objective to reduce the rate of VTE while minimizing adverse side effects such as bleeding Recently, aspirin has emerged as a promising prophylactic agent for patients undergoing arthroplasty due to its similar efficacy and good safety profile compared to other pharmacologic agents However, there is no evidence to date that clearly demonstrates the superiority of any given prophylactic agent Therefore, this review discusses (1) the current prevalence and trends in VTE after total hip and knee arthroplasty and (2) provides an update on pharmacologic VTE prophylaxis in regard to aspirin usage

The Predictive Value of the Clinical Frailty Scale on Discharge Destination and Complications in Older Hip Fracture Patients.

Abstract: Objectives To determine whether the Clinical Frailty Scale (CFS), a validated frailty tool, was associated with discharge destination. Secondary objectives were to determine whether the CFS was associated with in-hospital complications and length of stay. Design This is a 5-year retrospective cohort study. Setting The study took place at an academic Level 1 trauma center. Patients/participants All patients 65 years of age and older admitted with an isolated hip fracture were included (N = 423). Intervention Preadmission CFS was determined as part of routine clinical care prospectively and abstracted from the chart. Main outcome measurements We collected demographic and process data associated with adverse outcomes (age, sex, time to surgery, and mode of anesthesia) and used multivariable logistic regression to determine the association between CFS with discharge destination, in-hospital complications, and length of stay. Results Preadmission frailty was independently associated with adverse discharge destination (adjusted odds ratio 23.0; 95% confidence interval, 3.0-173.5) and in-hospital complications (adjusted odds ratio 4.8; 95% confidence interval, 2.1-10.8) in greater magnitude than traditional risk factors such as age, male sex, time to surgery, and mode of anesthesia. There was a dose-response relationship between increasing frailty and length of stay (P Conclusions Preadmission frailty as quantified by the CFS is associated with discharge destination, in-hospital complications, and length of stay. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Clinical Frailty Scale is a good predictor of mortality after proximal femur fracture: A cohort study of 30-day and one-year mortality.

Abstract: Aims A proximal femur fracture (PFF) is a common orthopaedic presentation, with an incidence of over 25,000 cases reported in the Australian and New Zealand Hip Fracture Registry (ANZHFR) in 2018. ...

Influence of Body Mass Index on Clinical Outcome Parameters, Complication Rate and Survival after Radical Cystectomy: Evidence from a Prospective European Multicentre Study.

Abstract: Background/Aims/Objectives: To evaluate the influence of body mass index (BMI) on complications and oncological outcomes in patients undergoing radical cystectomy (RC). Methods: Clinical and histopathological parameters of pa-tients have been prospectively collected within the "PRO-spective MulticEnTer RadIcal Cystectomy Series 2011". BMI was categorized as normal weight ( = 25-29.9 kg/m(2)) and obesity (>= 30 kg/m(2)). The association between BMI and clinical and histopathological endpoints was examined. Ordinal logistic regression models were applied to assess the influence of BMI on complication rate and survival. Results: Data of 671 patients were eligible for final analysis. Of these patients, 26% (n = 175) showed obesity. No significant association of obesity on tumour stage, grade, lymph node metastasis, blood loss, type of urinary diversion and 90-day mortality rate was found. According to the American Society of Anesthesiologists score, local lymph node (NT) stage and operative case load patients with higher BMI had significantly higher probabilities of severe complications 30 days after RC (p = 0.037). The overall survival rate of obese patients was superior to normal weight patients (p = 0.019). Conclusions: There is no evidence of correlation between obesity and worse oncological outcomes after RC. While obesity should not be a parameter to exclude patients from cystectomy, surgical settings need to be aware of higher short-term complication risks and obese patients should be counselled - accordingly. (C) 2018 S. Karger AG, Basel