Assuntos
Procedimentos Cirúrgicos Ambulatórios , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/mortalidade , Anestesia Local , Tomada de Decisão Clínica , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Alta do Paciente , Segurança do Paciente , Medição de Risco , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do TratamentoRESUMO
INTRODUCTION:: Ambulatory surgery is associated with lower costs, but there is lack of evidence of the safety for ambulatory vascular access surgery. The objective of this study is to substantiate the safety and effectiveness of performing vascular access surgery in an ambulatory setting. METHODS:: A review of our prospectively maintained database including all vascular access open surgeries (creations and repairs) performed by our Vascular Access Unit between 2013 and 2017 was compiled. Patient comorbidities, surgery details, hospital admission conditions, and 1-week and 1-month follow-up patency and complications (death, infection, bleeding, and readmission/reintervention) were scrutinized. RESULTS:: In the last 5 years, 1414 vascular access procedures were performed (67.8% access creations, 32.2% previous access repairs) in 1012 patients. Most surgeries were performed under local anesthesia (59.2%) or axillary plexus block (38.4%) and mainly in an ambulatory setting, without overnight hospital stays (90.9%). During the first postoperative week follow-up, 9 cases (0.6%) needed readmission or reintervention; significant infection materialized in 11 (0.8%) and 10 cases (0.7%) showed noteworthy hematoma or bleeding, only three (0.2%) requiring reintervention. The primary composite endpoint of 24-h death and 1 week readmission, reintervention, infection, or bleeding was 1.9% (27 cases); 1-month access failure was 6.2%. After univariate analysis, ambulatory settings were not related to higher rates of complications or readmissions. CONCLUSION:: Arteriovenous access surgery can be safely performed in an ambulatory setting, in spite of complex cases, comorbidities, or the increasing implementation of axillary plexus blocks. Surgical results and patency are good, and complications necessitating readmission remain very low.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Derivação Arteriovenosa Cirúrgica/métodos , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/mortalidade , Anestesia Local , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
PURPOSE: To document the incidence of specific complications and the mortality rate for office anesthesia administered by fully qualified oral and maxillofacial surgeons in the state of Massachusetts. MATERIALS AND METHODS: A survey questionnaire was mailed to the 169 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons. Using a specific method for follow-up, a 100% response was obtained. RESULTS: The frequency of office anesthetic complications occurring in 2004 were consistent with our previous studies. There was 1 office death, for a mortality rate of 1/1,733,055. The incidence of other specific anesthetic-related complications is documented. CONCLUSION: From the data presented here, we conclude that outpatient anesthesia in the oral and maxillofacial surgery office continues to be a safe therapeutic modality.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Anestesia Dentária/efeitos adversos , Procedimentos Cirúrgicos Bucais/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/mortalidade , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Anestesia Dentária/métodos , Anestesia Dentária/mortalidade , Anestesia Dentária/estatística & dados numéricos , Anestesia Geral/efeitos adversos , Anestesia Geral/mortalidade , Anestesia Geral/estatística & dados numéricos , Anestesia Local/efeitos adversos , Anestesia Local/estatística & dados numéricos , Anestésicos Inalatórios/efeitos adversos , Sedação Consciente/efeitos adversos , Sedação Consciente/mortalidade , Sedação Consciente/estatística & dados numéricos , Feminino , Humanos , Laringismo/etiologia , Masculino , Massachusetts , Pessoa de Meia-Idade , Óxido Nitroso/efeitos adversos , Procedimentos Cirúrgicos Bucais/mortalidade , Procedimentos Cirúrgicos Bucais/normas , Pneumonia Aspirativa/etiologia , Inquéritos e QuestionáriosRESUMO
PURPOSE: This retrospective study documented the frequency of various complications associated with outpatient anesthesia. PATIENTS AND METHODS: A questionnaire was mailed to the 157 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons (MSOMS) and all members responded. Morbidity data were obtained for the calendar year 1999. Mortality data included 1999 and the preceding 4 years. This continues our long-term survey of ambulatory oral surgical office deaths in Massachusetts since 1984. The data include anesthesia-related complications and all office deaths for the patients treated by these oral and maxillofacial surgeons. RESULTS: The most common complication in our survey continues to be syncope, which occurred in 1 in 160 patients receiving local anesthesia. The incidences of other specific anesthetic problems are given. Two treatment-related deaths occurred among approximately 1,706,100 patients treated during the 5-year period of 1995 through 1999, for a mortality rate of 1/853,050. CONCLUSIONS: The results of this retrospective practitioner survey documented the specific incidence of untoward anesthetic events with outpatient anesthesia and found a mortality rate consistent with the 6 similar mortality studies since 1980. These 7 retrospective reviews found 34/28,399,193 outpatient deaths for an overall dental anesthesia mortality rate of 1/835,000.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Anestesia Geral/efeitos adversos , Anestesia Local/efeitos adversos , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/mortalidade , Anestesia Dentária/efeitos adversos , Anestesia Dentária/mortalidade , Anestesia Geral/mortalidade , Anestesia Local/mortalidade , Criança , Sedação Consciente/efeitos adversos , Sedação Consciente/mortalidade , Humanos , Incidência , Laringismo/epidemiologia , Estudos Longitudinais , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Flebite/epidemiologia , Estudos Retrospectivos , Síncope/epidemiologiaRESUMO
All 147 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons responded to an anesthesia survey. They had treated 416,561 patients during 1989. This article reports the results of the survey and specific untoward anesthetic events as recalled by these practitioners. Use of various anesthetic agents in 1989 and 1984 are compared.