Author
Michelle L. de Oliveira
Bio: Michelle L. de Oliveira is an academic researcher from University of Zurich. The author has contributed to research in topics: Liver transplantation & Machine perfusion. The author has an hindex of 10, co-authored 17 publications receiving 6238 citations.
Papers
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TL;DR: This 5-year evaluation provides strong evidence that the classification of complications is valid and applicable worldwide in many fields of surgery, and subjective, inaccurate, or confusing terms such as “minor or major” should be removed from the surgical literature.
Abstract: Background and Aims:The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the co
7,537 citations
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TL;DR: This is the first report on cold machine perfusion of human liver grafts obtained after cardiac arrest and subsequent transplantation and application of HOPE appears well tolerated, easy-to-use, and protective against early and later injuries.
286 citations
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146 citations
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University of Zurich1, Children's of Alabama2, Toronto General Hospital3, Washington University in St. Louis4, University of Pennsylvania5, University of Hamburg6, Karolinska University Hospital7, Katholieke Universiteit Leuven8, Johns Hopkins University9, Hospital Italiano de Buenos Aires10, Erasmus University Medical Center11, University of Bologna12, University of Western Ontario13, University of Rochester Medical Center14
TL;DR: Despite excellent 1- year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up, and benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.
Abstract: This multicentric study of 17 high-volume centers presents 12 benchmark values for liver transplantation. Those values, mostly targeting markers of morbidity, were gathered from 2024 “low risk” cases, and may serve as reference to assess outcome of single or any groups of patients.Objective:To propo
138 citations
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TL;DR: Risk adjustment of patient selection and technique in ALPPS resulted in a continuous drop of early mortality and major postoperative morbidity, which has meanwhile reached standard outcome measures accepted for major liver surgery.
Abstract: OBJECTIVE To longitudinally assess whether risk adjustment in Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) occurred over time and is associated with postoperative outcome. BACKGROUND ALPPS is a novel 2-stage hepatectomy enabling resection of extensive hepatic tumors. ALPPS has been criticized for its high mortality, which is reported beyond accepted standards in liver surgery. Therefore, adjustments in patient selection and technique have been performed but have not yet been studied over time in relation to outcome. METHODS ALPPS centers of the International ALPPS Registry having performed ≥10 cases over a period of ≥3 years were assessed for 90-day mortality and major interstage complications (≥3b) of the longitudinal study period from 2009 to 2015. The predicted prestage 1 and 2 mortality risks were calculated for each patient. In addition, questionnaires were sent to all centers exploring center-specific risk adjustment strategies. RESULTS Among 437 patients from 16 centers, a shift in indications toward colorectal liver metastases from 53% to 77% and a reverse trend in biliary tumors from 24% to 9% were observed. Over time, 90-day mortality decreased from initially 17% to 4% in 2015 (P = 0.002). Similarly, major interstage complications decreased from 10% to 3% (P = 0.011). The reduction of 90-day mortality was independently associated with a risk adjustment in patient selection (P < 0.001; OR: 1.62; 95% CI: 1.36-1.93) and using less invasive techniques in stage-1 surgery (P = 0.019; OR: 0.39; 95% CI: 0.18-0.86). A survey indicated risk adjustment of patient selection in all centers and ALPPS technique in the majority (80%) of centers. CONCLUSIONS Risk adjustment of patient selection and technique in ALPPS resulted in a continuous drop of early mortality and major postoperative morbidity, which has meanwhile reached standard outcome measures accepted for major liver surgery.
101 citations
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01 Jan 2016
TL;DR: Aspirin has been widely used to prevent myocardial infarction and ischemic stroke, but some studies have suggested it increases risk of hemorrhagic stroke as mentioned in this paper, which is not the case here.
Abstract: Context.— Aspirin has been widely used to prevent myocardial infarction and ischemic stroke but some studies have suggested it increases risk of hemorrhagic stroke. Objective.— To estimate the risk of hemorrhagic stroke associated with aspirin treatment. Data Sources.— Studies were retrieved using MEDLINE (search terms, aspirin, cerebrovascular disorders, and stroke), bibliographies of the articles retrieved, and the authors’ reference files. Study Selection.— All trials published in English-language journals before July 1997 in which participants were randomized to aspirin or a control treatment for at least 1 month and in which the incidence of stroke subtype was reported. Data Extraction.— Information on country of origin, sample size, duration, study design, aspirin dosage, participant characteristics, and outcomes was abstracted independently by 2 authors who used a standardized protocol. Data Synthesis.— Data from 16 trials with 55 462 participants and 108 hemorrhagic stroke cases were analyzed. The mean dosage of aspirin was 273 mg/d and mean duration of treatment was 37 months. Aspirin use was associated with an absolute risk reduction in myocardial infarction of 137 events per 10 000 persons (95% confidence interval [CI], 107-167;P,.001) and in ischemic stroke, a reduction of 39 events per 10 000 persons (95% CI, 17-61; P,.001). However, aspirin treatment was also associated with an absolute risk increase in hemorrhagic stroke of 12 events per 10 000 persons (95% CI, 5-20; P,.001). This risk did not differ by participant or study design characteristics. Conclusions.— These results indicate that aspirin therapy increases the risk of hemorrhagic stroke. However, the overall benefit of aspirin use on myocardial infarction and ischemic stroke may outweigh its adverse effects on risk of hemorrhagic stroke in most populations.
1,450 citations
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TL;DR: The CCI summarizes all postoperative complications and is more sensitive than existing morbidity endpoints and may serve as a standardized and widely applicable primary endpoint in surgical trials and other interventional fields of medicine.
Abstract: Objective:To develop and validate a comprehensive complication index (CCI) that integrates all events with their respective severity.Background:Reporting of surgical complications is inconsistent and often incomplete. Most studies fail to provide information about the severity of complications, or i
1,024 citations
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Beth Israel Deaconess Medical Center1, University of Wisconsin-Madison2, University of Southampton3, Mayo Clinic4, Peking University5, Seoul National University Hospital6, Institut Gustave Roussy7, Anschutz Medical Campus8, Rhode Island Hospital9, Harvard University10, University Health Network11, London Clinic12, University of Wisconsin Hospital and Clinics13, University of Pisa14, Wayne State University15, University of California, Los Angeles16, University of California, Davis17, Albert Einstein Medical Center18
TL;DR: This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies and improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
Abstract: The main objective of this document is to improve precision in communication in the field of image-guided tumor ablation that leads to more accurate comparison of technologies and results and ultimately to improved patient outcomes.
1,001 citations
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TL;DR: Ongoing obstacles related to the study design of randomised controlled trials and non-randomised studies assessing surgical interventions are discussed.
555 citations
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TL;DR: The JCOG postoperative complications criteria (JCOG PC criteria) aim to standardize the terms used to define adverse events (AEs) and provide detailed grading guidelines based on the Clavien-Dindo classification.
Abstract: Prior to publication of the Clavien-Dindo classification in 2004, there were no grading definitions for surgical complications in either clinical practice or surgical trials. This report establishes supplementary criteria for this classification to standardize the evaluation of postoperative complications in clinical trials. The Japan Clinical Oncology Group (JCOG) commissioned a committee. Members from nine surgical study groups (gastric, esophageal, colorectal, lung, breast, gynecologic, urologic, bone and soft tissue, and brain) specified postoperative complications experienced commonly in their fields and defined more detailed grading criteria for each complication in accordance with the general grading rules of the Clavien-Dindo classification. We listed 72 surgical complications experienced commonly in surgical trials, focusing on 17 gastroenterologic complications, 13 infectious complications, six thoracic complications, and several other complications. The grading criteria were defined simply and were optimized for surgical complications. The JCOG postoperative complications criteria (JCOG PC criteria) aim to standardize the terms used to define adverse events (AEs) and provide detailed grading guidelines based on the Clavien-Dindo classification. We believe that the JCOG PC criteria will allow for more precise comparisons of the frequency of postoperative complications among trials across many different surgical fields.
507 citations