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1.
Comput Math Methods Med ; 2022: 3965039, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35495880

RESUMEN

Objective: To explore the cohort study of rivaroxaban combined with D-dimer dynamic monitoring in the prevention of deep venous thrombosis (DVT) after knee arthroplasty. Methods: Eighty-four patients with knee osteoarthritis who went through total knee arthroplasty from June 2019 to June 2021 in our hospital were arbitrarily assigned into the study group and the control group. The patients in the control group were cured with rivaroxaban anticoagulation after operation, and the study group was cured with dynamic monitoring of D-dimer on the basis of the control group. The incidence of postoperative DVT, pulmonary embolism (PE), and bleeding complications (incision ecchymosis and bleeding events) were compared. The related indexes such as drainage volume and blood transfusion volume were compared. The levels of activated partial prothrombin time (APPT), prothrombin time (PT), and D-dimer were dynamically monitored before and after operation. Visual analogue scale (VAS) was adopted to assess the degree of postoperative incision pain, the level of limb swelling before and after operation was measured, the circumference difference of affected limb was calculated, the ecchymosis area was assessed in the form of nine-palace grid, and the scores were compared. Results: According to the comparison of VAS score, there exhibited no remarkable difference before operation and on the first day after operation, but the VAS score decreased after operation, and the VAS score of the study group on the 3rd day, 7th day, and 14th day after operation was remarkably lower compared to the control group (P < 0.05). There exhibited no remarkable difference in drainage volume (P > 0.05), but the blood transfusion volume and total blood loss in the study group were remarkably lower (P < 0.05). There exhibited no remarkable difference in the level of PT on the 3rd day before operation and on the 3rd day after operation, but on the 7th day and 14th day after operation, the level of PT in the study group was remarkably higher (P < 0.05). The level of PT in the study group was remarkably higher (P < 0.05). There exhibited no remarkable difference in the level of APPT on the 3rd day before operation and on the 3rd day after operation, but on the 7th day and 14th day after operation, the level of APPT in the study group was remarkably higher (P < 0.05). The level of APPT in the study group was remarkably higher (P < 0.05). There exhibited no remarkable difference in the level of plasma D-dimer before operation (P > 0.05). The level of plasma D-dimer in the study group was lower (P < 0.05). In terms of the postoperative ecchymosis area score, the ecchymosis area score decreased remarkably after operation. Furthermore, the ecchymosis area score of the study group was remarkably lower (P < 0.05). In terms of the swelling degree of the affected limb, there exhibited no remarkable difference in thigh circumference and calf circumference before operation (P > 0.05), but after operation, the thigh circumference difference and calf circumference difference decreased, and the thigh circumference difference and calf circumference difference in the study group were lower (P < 0.05). The incidence of DVT in the study group was 16.67%, while that in the control group was 38.10%. No PE occurred in the two groups at the early stage after operation. There were 3 cases of incision ecchymosis, 1 case of bleeding event (incision oozing) in the study group, 11 cases of incisional ecchymosis, and 2 cases of bleeding event in the control group. In 3 patients with incisional bleeding, there were no obvious abnormalities in routine blood examination and blood coagulation indexes. The patients were given wound pressure bandaging and stopped using anticoagulants and changing wound dressings every day, all of which disappeared within 5 days. The incidence of early postoperative DVT and bleeding complications in the study group was lower (P < 0.05). Conclusion: Rivaroxaban combined with D-dimer dynamic monitoring has high clinical value in preventing DVT after knee arthroplasty and can effectively reduce the amount of blood loss during operation and the incidence of postoperative DVT, PE, and bleeding complications, which is worth popularizing to reduce the area of ecchymosis and the degree of pain after operation and shorten the recovery process.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Trombosis de la Vena , Artroplastia de Reemplazo de Rodilla/efectos adversos , Estudios de Cohortes , Equimosis/complicaciones , Equimosis/tratamiento farmacológico , Productos de Degradación de Fibrina-Fibrinógeno , Humanos , Dolor/complicaciones , Dolor/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Rivaroxabán/uso terapéutico , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & control
2.
J Visc Surg ; 159(1): 21-30, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-33349570

RESUMEN

PURPOSE OF THE STUDY: To determine the statistical indicators aimed at identifying patients for whom ambulatory colectomy could be proposed without additional risk. PATIENTS AND METHODS: The medical charts of patients who benefited from scheduled colonic or rectal resection during conventional hospitalization stays between 2018 and 2019 were reviewed. Eligibility for ambulatory colectomy was defined by hospital stay≤4 days and absence of any postoperative complication. Patient characteristics were compared, and the results were modeled in the form of a decision-making tree. The effect of an enhanced recovery after surgery (ERAS) protocol for each sub-group was calculated. RESULTS: One hundred and ten (110) patients were selected (41 "eligible" and 69 "non-eligible"). Median age was 73 years (27-95). Nearly 80% of the patients were operated for cancer. In multivariate analysis, age (≥65 years, OR=3.15, CI95%=1.22-8.12), diabetes (OR=3.91, CI95%=1.03-14.8) and indication (sigmoidectomy for diverticulosis, OR=0.21, CI=95%=0.05-0.9) were the only identified independent variables. Likelihood for ambulatory eligibility was 83.3% (<65 years, sigmoidectomy pour diverticulosis, +ERAS=92%-96.9%), 58.3% (<65 years, other indication, +ERAS=63.4%-89.9%), 35.7% (≥65 years without diabetes, +ERAS=40.0%-55.9%) and 8.3% (≥65 years with diabetes, +ERAS=10.0%-20.1%). CONCLUSION: Sigmoidectomy for diverticulosis in a patient under 65 years age represents the best indication for ambulatory colectomy, a procedure that must not be proposed to diabetic patients over 65 years of age. In the other cases (<65 years operated in another indication and non-diabetic≥65 years), ambulatory surgery is possible, pending satisfactory application of the ERAS protocol.


Asunto(s)
Recuperación Mejorada Después de la Cirugía , Laparoscopía , Proctectomía , Anciano , Colectomía/métodos , Colon/cirugía , Humanos , Laparoscopía/métodos , Tiempo de Internación , Complicaciones Posoperatorias/etiología
3.
Childs Nerv Syst ; 38(2): 311-317, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-34611762

RESUMEN

INTRODUCTION: Hydrocephalus persists in 10-40% of children with posterior fossa tumours (PFT). A delay in commencement of adjuvant therapy (AT) can negatively influence survival. The objective of this study was to determine whether postoperative cerebrospinal fluid (CSF) diversion procedures caused potentially preventable delays in AT. METHODS: A retrospective study of children diagnosed with PFT requiring AT from 2004 to 2018 from two large centres was conducted. Data on histology, timing of ventriculo-peritoneal shunt (VPS) insertion, and AT was collected. The modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) score was calculated. The primary outcome was delay in AT beyond 40 days post-resection. Progression-free and overall survival were assessed. RESULTS: Out of 196 primary PFT resections, 144 fitted the inclusion criteria. Mean age was 6.57 ± 4.62. Histology was medulloblastoma (104), ependymoma (27), and others (13). Forty patients had a VPS inserted; 17 of these experienced a delay in AT. A total of 104 patients were not shunted; 15 of these had delayed AT (p = 0.0007). Patients who had a VPS insertion had longer intervals from surgery to commencement of AT (34.5 vs 30.8, p = 0.05). There was no significant difference in mCPPRH score between those who had a VPS (4.03) and those who did not (3.61; p = 0.252). Multivariable linear regression modelling did not show a significant effect of VPS or mCPPRH on progression-free survival or OS. CONCLUSION: CSF diversion procedures may cause a preventable delay in the initiation of adjuvant therapy. Early post-operative VP shunt insertion, rather than a 'wait and see policy' should be considered in order to reduce this delay.


Asunto(s)
Neoplasias Cerebelosas , Hidrocefalia , Neoplasias Infratentoriales , Canadá , Neoplasias Cerebelosas/cirugía , Niño , Preescolar , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiología , Hidrocefalia/cirugía , Lactante , Neoplasias Infratentoriales/complicaciones , Neoplasias Infratentoriales/cirugía , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Derivación Ventriculoperitoneal/efectos adversos
4.
Am J Clin Oncol ; 45(7): 298-305, 2022 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-35700084

RESUMEN

PURPOSE: The purpose of his study was to report on a cohort of patients managed with nonoperative management (NOM) with a watch-and-wait strategy after achieving complete response (CR) to sequential short-course radiation therapy (SCRT) and consolidation chemotherapy. METHODS: This was a retrospective study of patients treated SCRT and chemotherapy who achieved a CR and were managed with NOM. Bowel function was assessed with European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30, EORTC Quality of Life Questionnaire-Colorectal Cancer 29, and the low anterior resection syndrome (LARS) questionnaires. Endpoints included overall survival (OS), freedom from local failure (FFLF), freedom from distant metastasis, and disease-free survival (DFS). RESULTS: Twenty-six patients met inclusion criteria. Seven (26.9%) patients developed local failure at a median of 6.8 months following CR, of which 5 were successfully salvaged. Median FFLF was not reached, with 6-month, 1-, and 2-year FFLF rates of 100.0%, 82.3%, and 71.3%. Median OS was not reached, with 6-month, 1-, and 2-year OS rates of 100%. Median DFS was not reached, with 6-month, 1-, and 2-year DFS rates of 100%, 95.0%, and 89.4%. Questionnaire response rate was 83.3%. Median LARS score was 27. Major, minor, and no LARS occurred in 3 (20%), 6 (40%), and 6 (40%) patients, respectively. There were no differences in questionnaire scores between patients who had the majority of their anal sphincter complex irradiated and those who did not. CONCLUSION: NOM with a watch-and-wait strategy is safe and feasible in patients with locally advanced rectal cancer who achieve CR after sequential SCRT and chemotherapy, with evidence for good anorectal function.


Asunto(s)
Neoplasias del Recto , Humanos , Terapia Neoadyuvante , Complicaciones Posoperatorias , Calidad de Vida , Neoplasias del Recto/patología , Estudios Retrospectivos , Síndrome
5.
J Am Coll Surg ; 234(6): 1137-1146, 2022 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-35703812

RESUMEN

BACKGROUND: Emerging literature suggests that measures of social vulnerability should be incorporated into surgical risk calculators. The Social Vulnerability Index (SVI) is a measure designed by the CDC that encompasses 15 socioeconomic and demographic variables at the census tract level. We examined whether adding the SVI into a parsimonious surgical risk calculator would improve model performance. STUDY DESIGN: The eight-variable Surgical Risk Preoperative Assessment System (SURPAS), developed using the entire American College of Surgeons (ACS) NSQIP database, was applied to local ACS-NSQIP data from 2012 to 2018 to predict 12 postoperative outcomes. Patient addresses were geocoded and used to estimate the SVI, which was then added to the model as a ninth predictor variable. Brier scores and c-indices were compared for the models with and without the SVI. RESULTS: The analysis included 31,222 patients from five hospitals. Brier scores were identical for eight outcomes and improved by only one to two points in the fourth decimal place for four outcomes with addition of the SVI. Similarly, c-indices were not significantly different (p values ranged from 0.15 to 0.96). Of note, the SVI was associated with most of the eight SURPAS predictor variables, suggesting that SURPAS may already indirectly capture this important risk factor. CONCLUSION: The eight-variable SURPAS prediction model was not significantly improved by adding the SVI, showing that this parsimonious tool functions well without including a measure of social vulnerability.


Asunto(s)
Complicaciones Posoperatorias , Vulnerabilidad Social , Bases de Datos Factuales , Humanos , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo
7.
Ann Plast Surg ; 88(5 Suppl 5): S403-S409, 2022 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-35690934

RESUMEN

BACKGROUND: Mastectomy skin flap necrosis (MSFN) can significantly impact outcome after immediate breast reconstruction. Several techniques exist to predict MSFN, but these may require additional testing and information, and they are often not available before surgery. We aim to identify whether breast volume, as calculated from preoperative mammography, can be used as a preoperative predictor of MSFN. METHODS: A retrospective chart review from 2010 to 2020 resulted in 378 patients who underwent immediate implant-based breast reconstruction. Complete imaging data were available for 278 patients and 441 reconstructed breasts. Demographic, perioperative, and outcomes data were collected. Measurements from preoperative diagnostic mammograms were used to calculate breast volume. Univariate and multivariate analyses were used to evaluate the association of variables available preoperatively, including breast volume from mammogram and MSFN. Secondary analyses were performed for need for reoperation and loss of reconstruction. RESULTS: On univariate analysis of MSFN development, demographic variables found to be significantly associated with MSFN included body mass index (P = 0.04), diabetes (P = 0.03), and breast volume calculated from routine mammography (P ≤ 0.0001). Average preoperative breast volume via mammography without and with MSFN was 970.6 mL (95% confidence interval [CI], 908.9-1032.3) and 1298.3 mL (95% CI, 1140.0-1456.5) (P < 0.0001), respectively. Statistically significant intraoperative variables for MSFN development included prolonged operative time (P = 0.005), greater initial tissue expander fill volumes (P ≤ 0.001), and prepectoral implant location (P = 0.02). Higher initial tissue expander fill volumes in implant-based reconstructions were associated with increased rates of MSFN, 264.1 mL (95% CI, 247.2-281.0) without MSFN and 349.9 mL (95% CI, 302.0-397.8) in the group with MSFN, respectively (P < 0.001). On multivariate analysis, preoperative imaging volume (P = 0.02) was found to be significant, whereas body mass index and diabetes lost significance (P = 0.40) in association with MSFN. CONCLUSIONS: The results of this study establish an association between larger breast volume on preoperative imaging and development of MSFN. This may be useful as a tool for more appropriate patient selection and guidance in the setting of immediate breast reconstruction.


Asunto(s)
Implantes de Mama , Neoplasias de la Mama , Mamoplastia , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mamoplastia/métodos , Mastectomía/métodos , Necrosis/etiología , Necrosis/cirugía , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Colgajos Quirúrgicos/cirugía
8.
Ann Plast Surg ; 88(5 Suppl 5): S410-S413, 2022 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-35690935

RESUMEN

PURPOSE: This study aimed to determine the impact of the quantity of acellular dermal matrix (ADM), "ADM burden," used in implant-based breast reconstruction on infection, drain duration, and seroma formation. METHODS: A single-institution, retrospective review from 2015 to 2020 was conducted for patients who underwent immediate, implant-based breast reconstruction after mastectomy. Three cohorts were generated based on the amount of ADM used: (1) total ADM, (2) sling ADM, and (3) no ADM. RESULTS: In total, there were 374 patients who satisfied the inclusion criteria yielding 641 breasts with 143, 432, and 66 breasts in the total ADM, sling ADM, and no-ADM groups, respectively. The no-ADM group had higher mastectomy weights (788.4 g) than the sling (654.2 g) and total ADM (503.4 g) groups (F = 10.8, P < 0.001). Total ADM had higher rates of explantation secondary to infection compared with no ADM (P < 0.001). Linear regression analysis for drain duration was significant for body mass index (P < 0.0001) but not for ADM quantity (P = 0.52). Logistic regression analysis demonstrated a higher risk of infection in the total ADM group (odds ratio [OR], 5.4; P < 0.0001). Diabetes mellitus was a risk factor for both infection (OR, 3.6; P = 0.05) and seroma formation (OR, 0.04; P = 0.04). CONCLUSIONS: Higher ADM burden is associated with an increased risk of infections and device explantation secondary to those infections. Although ADM has created new avenues in breast reconstruction, these findings indicate a need to evolve the technique to minimize the ADM burden. By doing so, patients can minimize their risk of postoperative complications while reducing the financial impact on institutions.


Asunto(s)
Dermis Acelular , Implantación de Mama , Implantes de Mama , Neoplasias de la Mama , Mamoplastia , Dermis Acelular/efectos adversos , Implantación de Mama/métodos , Implantes de Mama/efectos adversos , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mamoplastia/métodos , Mastectomía/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Seroma/epidemiología , Seroma/etiología
9.
Ann Plast Surg ; 88(5 Suppl 5): S485-S489, 2022 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-35690943

RESUMEN

BACKGROUND: Microsurgical reconstruction is an integral part of plastic surgery. The 5-factor modified frailty index (5-mFI) is an effective tool to predict postoperative complications across multiple subspecialties. We aimed to determine if frailty scores using the 5-mFI can predict postoperative complications specifically in microvascular reconstruction. STUDY DESIGN: Frailty scores were retrospectively assessed in microsurgical reconstruction patients (2012-2016) using the American College of Surgeons National Quality Improvement Program base. The 5 variables that comprise the 5-mFI are history of chronic obstructive pulmonary disease, history of congestive heart failure, functional status, hypertension requiring medication and diabetes. The data were analyzed using the Goodman test, χ2 test, and a logistic regression model. The congruence was also compared between the 5-mFI and the American Society of Anesthesiology (ASA) classification in predicting complications. RESULTS: Of 5894 patients, the highest 5-mFI value was "3." Analyses show an increase in postoperative complications requiring ICU care. Further models indicate an association between readmission with hypertension and chronic obstructive pulmonary disease (P < 0.05). There was an increased risk of a failure to wean from ventilator with a history of chronic obstructive pulmonary disease and diabetes and an increased risk of readmission with a history of hypertension and chronic obstructive pulmonary disease. The 5-mFI and ASA were incongruent in predicting postoperative complications. CONCLUSIONS: The 5-mFI predicts postoperative complications in the microsurgical reconstruction population. Although the 5-mFI and ASA predict different complications, their use provides insight into the potential adjustable risks before surgery.


Asunto(s)
Diabetes Mellitus , Fragilidad , Hipertensión , Enfermedad Pulmonar Obstructiva Crónica , Diabetes Mellitus/epidemiología , Fragilidad/complicaciones , Fragilidad/diagnóstico , Fragilidad/epidemiología , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Estados Unidos
10.
Ann Plast Surg ; 88(5 Suppl 5): S501-S507, 2022 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-35690947

RESUMEN

BACKGROUND: Gender affirmation surgery is an exponentially growing field within plastic surgery. The aim of our study is to analyze demographics, procedure type, trends, and outcomes in the surgical management of gender identity disorder in the past few years. METHODS: The American College of Surgeons NSQIP database was queried for the years 2015 to 2019. International Classification of Diseases codes were used to identify all gender-affirming cases. Patients were categorized by procedure type using Current Procedural Terminology codes for feminizing/masculinizing top, bottom and head/neck procedures. Patient demographics, comorbidities, and postoperative complications were analyzed using SPSS statistics software. A comparative analysis was performed among the procedure type. RESULTS: From 2015 to 2019, 4114 patients underwent a gender-affirming surgery (GAS) increasing the number of surgeries by over 400%, according to the NSQIP database. Demographics include age (mean = 32 years), body mass index (mean = 28 kg/m2), race (60% White, 22% unknown, 13% African American, 4% Asian, 1% other). Female to male procedures represented the most commonly performed (n = 2647; 64%), followed by male to female (n = 1278; 31%) with head/neck procedures representing 5% (n = 189) of all procedures. Top surgeries were also the most common (n = 2347, 57%), followed by bottom surgeries (n = 1578, 38%). The overall complication rate was 6% (n = 247), 2.1% (n = 4) for head/neck procedures, 8% (n = 134) for bottom procedures, and 3.5% (n = 84) for top surgeries.A reoperation within 30 days and related to the initial GAS occurred for 52 patients. Postoperative complication rates were statistically different between bottom surgeries compared with the top and head/neck procedure groups (P < 0.001). Increasing age and body mass index showed a significantly higher odds of having a complication. CONCLUSIONS: Gender-affirming procedures have significantly increased over the past 5 years. Increased exposure through literature and research, as well as an improvement in social climates, including increasing insurance coverage have contributed to the expansion of these procedures. Low serious complication rates within 30 days prove GAS to be safe.


Asunto(s)
Disforia de Género , Cirugía de Reasignación de Sexo , Adulto , Demografía , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad , Estudios Retrospectivos
11.
J Craniomaxillofac Surg ; 50(6): 493-498, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35672203

RESUMEN

The aim of this study was to evaluate the impact of drainless parotidectomy using fibrin sealant on length of stay, post-operative seroma and related complications. For this purpose, a retrospective matched case-control series was held in a single academic center. All patients who underwent drainless parotidectomies, including deep lobe tumors and revision surgeries, were compared to matched controls in which a suction drain was inserted. Main outcomes were length of hospital stay and post-operative seroma. A total of 123 patients (41 cases and 82 controls) were included in the study. Fibrin sealant group had higher rates of total parotidectomy compared with the control group (25.0% vs. 10.5%, p = 0.054). Length of stay was significantly shorter in the fibrin sealant group (1.0 ± 0.3 days vs. 1.5 ± 0.6 days, p < 0.001, respectively). No statistically significant difference was found between the fibrin sealant group and the control regarding post-operative seromas (9.8% vs. 14.6%, p = 0.574, respectively), aspirations rate (7.3% vs. 14.6%, p = 0.381), and infection rates (0% vs.3.7%, p = 0.550). In conclusion, drainless parotidectomy does not increase post operative seroma rates and related complications, and can also be implemented for revision surgery.


Asunto(s)
Adhesivo de Tejido de Fibrina , Adhesivos Tisulares , Estudios de Casos y Controles , Drenaje , Adhesivo de Tejido de Fibrina/uso terapéutico , Humanos , Tiempo de Internación , Complicaciones Posoperatorias , Estudios Retrospectivos , Seroma/etiología , Adhesivos Tisulares/uso terapéutico
12.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 53(3): 488-492, 2022 May.
Artículo en Chino | MEDLINE | ID: mdl-35642159

RESUMEN

Objective: To explore the surgical safety of patients with comorbid non-small cell lung cancer (NSCLC) and pneumoconiosis. Methods: In this study, the clinical data of 165 NSCLC patients treated at West China Fourth Hospital, Sichuan University from August 2019 to May 2021 were collected. Among them, 21 patients with comorbid pneumoconiosis were included in the pneumoconiosis group, and the remaining 144 patients were included in the general group. Radical resection for lung cancer was performed in both groups. The perioperative clinical data, including preoperative, intraoperative and postoperative indicators, of the two groups were compared and analyzed. Results: There was no perioperative death in either group. The proportions of male patients and patients with smoking history in the pneumoconiosis group were significantly higher than those in the general group ( P<0.05). The body mass index (BMI), pulmonary ventilation function and diffusion function in the pneumoconiosis group were significantly lower than those in the general group ( P<0.05). There was no significant difference in the median operative time and the median volume of intraoperative blood loss between the pneumoconiosis group and the general group. In the pneumoconiosis group, the proportion of advanced tumors (stage Ⅱ/Ⅲ), incidence of postoperative complications, median duration of postoperative intubation, and postoperative length of hospital stay were higher/longer than those of the normal group ( P<0.05). Compared with the general group, the incidences of lymph node calcification, dense pleural adhesion and surgical method alteration (switching from thoracoscopic surgery to open surgery or video-assisted thoracoscopy) were also significantly higher in the pneumoconiosis group ( P<0.05). Univariate analysis showed that age, smoking history, pneumoconiosis, pulmonary ventilation dysfunction, lymph node calcification, dense pleural adhesion and the volume of intraoperative blood loss were the risk factors for postoperative complications. Further multivariate regression analysis demonstrated that smoking history ( OR=1.37, P<0.05), lymph node calcification ( OR=2.36, P<0.05) and pulmonary ventilation dysfunction ( OR=5.21, P<0.05) were independent risk factors for postoperative complications. Conclusion: NSCLC patients with comorbid pneumoconiosis face relatively greater risks during the perioperative period when they undergo radical resection for lung cancer. Therefore, the close attention of surgeons and the nursing staff should be raised accordingly.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Neumoconiosis , Pérdida de Sangre Quirúrgica , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/cirugía , Masculino , Periodo Perioperatorio , Neumoconiosis/complicaciones , Neumoconiosis/epidemiología , Neumoconiosis/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Cirugía Torácica Asistida por Video/efectos adversos
13.
BMC Geriatr ; 22(1): 475, 2022 06 02.
Artículo en Inglés | MEDLINE | ID: mdl-35650535

RESUMEN

BACKGROUND: As the incidence of gastric cancer increases in elderly patients worldwide, laparoscopic gastrectomy (LG) for elderly patients with gastric cancer is also increasing. However, whether LG is an optimal surgical modality for elderly patients with gastric cancer remains unclear. This study aimed to evaluate the technical and oncological safety of LG for elderly patients ≥ 80 years old with gastric cancer. METHODS: Patients who received curative gastrectomy for gastric cancer from 2003 to 2015 were enrolled in the study. They were divided into the LG in elderly patients aged over 80 years (LG-E) group, open gastrectomy (OG) in elderly patients (OG-E) group, and LG in non-elderly patients < 80 years (LG-NE) group. Patients' demographics and short- and long-term outcomes, such as postoperative complications and 5-year survival rate, were compared between the three groups, retrospectively. RESULTS: The LG-E, OG-E, and LG-NE groups comprised 45, 43, and 329 patients, respectively. In the comparison between the LG-E and OG-E groups, the incidence of distal gastrectomy (DG) and the proportions of patients with pathological tumor stage T1, pathological N0, and final stage I were significantly higher in the LG-E versus OG-E group (89 vs. 56%, 76% vs. 16%, 82% vs. 37%, and 84% vs. 35%, p < 0.01, respectively). Blood loss and the incidence of overall postoperative complications in the LG-E group were significantly lower than those in the OG-E group (40 vs. 240 g, p < 0.01, and 29% vs. 53%, p < 0.05, respectively). Although the 5-year overall survival (OS) rate was not significantly different between the two groups, the 5-year disease-specific survival (DSS) rate was significantly higher in the LG-E group versus OG-E group (93% vs. 78%, p < 0.05). Overall comorbidities were significantly higher in the LG-E group versus LG-NE group, but there were no significant differences in short-term outcomes between the two groups. Further, although the 5-year OS rate was significantly lower in the LG-E group versus LG-NE group (67% vs. 87%, p < 0.01), there was no significant difference between the two groups in 5-year DSS rate. CONCLUSION: LG is technically and oncologically safe for the treatment of gastric cancer in both elderly patients aged ≥ 80 years and the non-elderly and can be an optimal surgical modality for elderly patients with gastric cancer.


Asunto(s)
Laparoscopía , Neoplasias Gástricas , Anciano , Anciano de 80 o más Años , Gastrectomía/efectos adversos , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Neoplasias Gástricas/cirugía
14.
Acta Obstet Gynecol Scand ; 101(7): 705-718, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35661342

RESUMEN

INTRODUCTION: The aim of this study was to analyze the available literature by conducting a systematic review to assess the possible effects of nerve-sparing segmental resection and conventional bowel resection on postoperative complications for the treatment of colorectal endometriosis. MATERIAL AND METHODS: Pubmed, Clinical Trials.gov, Cochrane Library, and Web of Science were comprehensively searched from 1997 to 2021 in order to perform a systematic review. Studies including patients undergoing segmental resection for colorectal endometriosis including adequate follow-up, data on postoperative complications and postoperative sequelae were enrolled in this review. Selected articles were evaluated and divided in two groups: Nerve-sparing resection (NSR), and conventional segmental resection not otherwise specified (SRNOS). Within the NSRs, studies mentioning preservation of the rectal artery supply (artery and nerve-sparing SR - ANSR) and not reporting preservation of the artery supply (NSR not otherwise specified - NSRNOS) were further analyzed. PROSPERO ID: CRD42021250974. RESULTS: A total of 7549 patients from 63 studies were included in the data analysis. Forty-three of these publications did not mention the preservation or the removal of the hypogastric nerve plexus, or main rectal artery supply and were summarized as SRNOS. The remaining 22 studies were listed under the NSR group. The mean size of the resected deep endometriosis lesions and patients' body mass index were comparable between SRNOS and NSR. A mean of 3.6% (0-16.6) and 2.3% (0-10.5%) of rectovaginal fistula development was reported in patients who underwent SRNOS and NSR, respectively. Anastomotic leakage rates varied from 0% to 8.6% (mean 1.7 ± 2%) in SRNOS compared with 0% to 8% (mean 1.7 ± 2%) in patients undergoing NSR. Urinary retention (4.5% and 4.9%) and long-term bladder catheterization (4.9% and 5.6%) were frequently reported in SRNOS and NSR. There was insufficient information about pain or the recurrence rates for women undergoing SRNOS and NSR. CONCLUSIONS: Current data describe the outcomes of different segmental resection techniques. However, the data are inhomogeneous and not sufficient to reach a conclusion regarding a possible advantage of one technique over the other.


Asunto(s)
Neoplasias Colorrectales , Endometriosis , Laparoscopía , Enfermedades del Recto , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/cirugía , Endometriosis/complicaciones , Femenino , Humanos , Laparoscopía/métodos , Complicaciones Posoperatorias/etiología , Enfermedades del Recto/cirugía , Resultado del Tratamiento
15.
Medicine (Baltimore) ; 101(22): e29303, 2022 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-35665731

RESUMEN

BACKGROUND: Postoperative pancreatic fistula is one of the most critical complications following pancreatic surgery. This study aimed to evaluate the utility of selective prophylactic octreotide for patients at high risk of developing postoperative pancreatic fistula. METHODS: From June 2019 to July 2020, 263 patients underwent pancreatoduodenectomy with pancreatojejunostomy at Samsung Medical Center. The individual fistula risk scores were calculated using a previously developed nomogram. The clinicopathological data of the patients were retrospectively reviewed. RESULTS: There were 81 patients in the low-risk group and 182 patients in the high-risk group. No statistically significant differences were found in the rates of clinically relevant postoperative pancreatic fistula between octreotide group and the control group in all patients (15.0% vs 14.7%, P = .963) and in the high-risk group (16.1% vs 23.6%, P = .206). In risk factor analysis, postoperative octreotide was not an independent risk factor for clinically relevant pancreatic fistula in all patients and the high-risk group. Drain fluid amylase levels on the first postoperative day were significantly associated with clinically relevant postoperative pancreatic fistula, regardless of the individual risk. CONCLUSIONS: The selective use of octreotide, even in high-risk patients, showed no protective effect against pancreatic fistula. Therefore, the routine use of postoperative octreotide is not recommended.


Asunto(s)
Fístula Pancreática , Pancreaticoduodenectomía , Humanos , Octreótido/uso terapéutico , Fístula Pancreática/etiología , Fístula Pancreática/prevención & control , Pancreaticoduodenectomía/efectos adversos , Pancreatoyeyunostomía/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Factores de Riesgo
16.
Nutrients ; 14(11)2022 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-35684155

RESUMEN

BACKGROUND: One anastomosis gastric bypass (OAGB) is safe and effective. Its strong malabsorptive component might cause severe protein-energy malnutrition (PEM), necessitating revisional surgery. We aimed to evaluate the safety and outcomes of OAGB revision for severe PEM. METHODS: This was a single-center retrospective analysis of OAGB patients undergoing revision for severe PEM (2015-2021). Perioperative data and outcomes were retrieved. RESULTS: Ten patients underwent revision for severe PEM. Our center's incidence is 0.63% (9/1425 OAGB). All patients were symptomatic. Median (interquartile range) EWL and lowest albumin were 103.7% (range 57.6, 114) and 24 g/dL (range 19, 27), respectively, and 8/10 patients had significant micronutrient deficiencies. Before revision, nutritional optimization was undertaken. Median OAGB to revision interval was 18.4 months (range 15.7, 27.8). Median BPL length was 200 cm (range 177, 227). Reversal (n = 5), BPL shortening (n = 3), and conversion to Roux-en-Y gastric bypass (RYGB) (n = 2) were performed. One patient had anastomotic leak after BPL shortening. No death occurred. Median BMI and albumin increased from 22.4 kg/m2 (range 20.6, 30.3) and 35.5 g/dL (range 29.2, 41), respectively, at revision to 27.5 (range 22.2, 32.4) kg/m2 and 39.5 g/dL (range 37.2, 41.7), respectively, at follow-up (median 25.4 months, range 3.1, 45). Complete resolution occurs after conversion to RYGB or reversal to normal anatomy, but not after BPL shortening. CONCLUSIONS: Revisional surgery of OAGB for severe PEM is feasible and safe after nutritional optimization. Our results suggest that the type of revision may be an important factor for PEM resolution. Comparative studies are needed to define the role of each revisional option.


Asunto(s)
Derivación Gástrica , Obesidad Mórbida , Desnutrición Proteico-Calórica , Albúminas , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Humanos , Obesidad Mórbida/complicaciones , Complicaciones Posoperatorias/etiología , Desnutrición Proteico-Calórica/complicaciones , Desnutrición Proteico-Calórica/cirugía , Estudios Retrospectivos , Pérdida de Peso
17.
Comput Math Methods Med ; 2022: 9110676, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35693272

RESUMEN

Objective: Evaluate the influence of laparoscopy combined with choledochoscopy on operation-related indexes, serum total bilirubin (TBIL) level, and abdominal drainage tube extraction time within cases carrying cholecystolithiasis/choledocholithiasis. Methods: 86 cases of cholecystolithiasis together with choledocholithiasis were chosen for this investigation, and cases were randomly segregated within the control cohort (43 cases, open surgery) and observation cohort (43 cases, laparoscopy combined with choledochoscopy).The operation-related indexes, complete stone clearance rate, postoperative visual analogue scale (VAS) scoring, serum TBIL level, and postsurgical complications/recovery incidence were observed and comparatively analyzed across cohorts. Results: Compared with the control cohort, the incision length, operation duration, postoperative exhaust duration, abdominal drainage tube extraction time, and postsurgery hospitalization in observation cohort were markedly reduced (P < 0.05), the intrasurgical hemorrhaging was markedly reduced (P < 0.05), and the postoperative complication incidences were markedly reduced (P < 0.05). Furthermore, the complete stone clearance rates in the observation cohort were elevated compared with control, but the difference was not statistically significant (P > 0.05).VAS scoring for the observation cohort at 6, 12, 24, and 48 hours postsurgery was markedly reduced (P < 0.05). On the first day after the operation, the serum TBIL levels for the two cohorts were very high and gradually decreased, and the serum TBIL levels in the observation cohort were markedly reduced during day 1, 3, and 5 postsurgery (P < 0.05). Conclusion: Laparoscopy combined with choledochoscopy surgical treatment might reduce the surgery duration, intrasurgery hemorrhaging, postsurgical pain, and liver function damage.


Asunto(s)
Colecistolitiasis , Coledocolitiasis , Laparoscopía , Colecistolitiasis/complicaciones , Colecistolitiasis/cirugía , Coledocolitiasis/complicaciones , Coledocolitiasis/diagnóstico por imagen , Coledocolitiasis/cirugía , Drenaje , Humanos , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del Tratamiento
18.
J Am Coll Surg ; 234(6): 1101-1109, 2022 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-35703805

RESUMEN

BACKGROUND: Postoperative urinary tract infections (UTIs) are associated with increased lengths of stay, inpatient costs, and mortality. Review of institutional data from the American College of Surgeons (ACS) NSQIP revealed opportunities to improve practices with respect to urinary catheter (Foley) insertion, catheter care, adherence to diagnosis and prevention protocols, and ACS NSQIP reporting. STUDY DESIGN: A multidisciplinary quality improvement team convened and implemented interventions based on a literature review and analysis of institutional drivers of postoperative UTI. The team educated the ACS NSQIP surgical clinical reviewers and clinical teams about UTI diagnostic criteria and prevention, trained staff in proper catheterization technique, and provided performance feedback. The team also developed kits with supplies and instructions for patients who were discharged home with catheters, along with an instructional video. The investigators evaluated project effectiveness by comparing pre- and postintervention process measures and rates of postoperative UTI. RESULTS: After interventions, compliance rates improved for hand hygiene (62% to 83%, p = 0.04), precleansing of the periurethral area (66% to 97%, p = 0.001), and catheter positioning (41% to 93%, p < 0.001), and the composite performance (10% to 73%, p < 0.001). Surgery residents' scores on a UTI knowledge assessment improved from 71% to 81% (p = 0.005). The majority of residents and staff strongly agreed that the training sessions would change their practice (57% and 69%, respectively). The unadjusted rate of postoperative UTIs at our institution decreased from 1.55% to 0.69% (p = 0.016), corresponding to an improvement in the ACS NSQIP odds ratio from 1.51 to 0.86. CONCLUSIONS: A series of interventions, including provider training, patient education, and audits of practice with performance feedback, are associated with improvements in both practice and the incidence of postoperative UTI.


Asunto(s)
Infecciones Urinarias , Humanos , Incidencia , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad , Catéteres Urinarios/efectos adversos , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & control
19.
Rev Med Suisse ; 18(786): 1218-1222, 2022 Jun 15.
Artículo en Francés | MEDLINE | ID: mdl-35703865

RESUMEN

During surgical procedures, surgery, and anesthesia lead to pathophysiological stress on the human body. The goal of perioperative medicine is to prepare patients and take all possible measures to reduce this pathophysiological stress. The emergence of ERAS over the past 15 years has made it possible to set up a multimodal program based on scientific evidence, showing that the adequate application of an improved rehabilitation program after surgery, ERAS-type, is possible in all surgical specialties, including gynecology, cardiac surgery, and neurosurgery. ERAS improves the quality of life of patients, reduces postoperative complications and lengths of stay, and finally, reduces costs. The purpose of this article is to show the most important elements of such an ERAS program by taking the example of digestive surgery.


La chirurgie et l'anesthésie entraînent un stress pathophysiologique de l'organisme. Le but de la médecine périopératoire est de préparer les patients et de prendre toutes les mesures possibles pour diminuer ce stress physiologique. L'émergence de ERAS (Enhanced Rehabilitation After Surgery ; réhabilitation améliorée après chirurgie) ces 15 dernières années a permis de mettre sur pied un programme multimodal basé sur des preuves scientifiques montrant que l'application adéquate d'un programme de type ERAS dans l'ensemble des spécialités chirurgicales, y compris la gynécologie, la chirurgie cardiaque et la neurochirurgie, permet d'améliorer la qualité de vie des patients, de diminuer les complications postopératoires, les durées de séjour et, finalement, les coûts. Le but de cet article est de montrer les éléments les plus importants d'un tel programme ERAS en prenant l'exemple de la chirurgie digestive.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Calidad de Vida , Humanos , Tiempo de Internación , Atención Perioperativa/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control
20.
J Am Coll Surg ; 235(1): 60-68, 2022 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-35703963

RESUMEN

BACKGROUND: Recent socioeconomic pressures in healthcare and work hour resections have limited opportunities for resident autonomy and independent decision-making. We sought to evaluate whether contemporary senior residents are being given the opportunity to operate independently and whether patient outcomes are affected when the attending is not directly involved in an operation. STUDY DESIGN: The VA Surgical Quality Improvement Program (VASQIP) Database was queried to identify patients undergoing elective laparoscopic cholecystectomy between 2004 and 2019. Cases were categorized as "attending" or "resident" depending on whether the attending surgeon was scrubbed. Cohorts were 1:1 propensity score-matched (PSM) for demographics, comorbidities, and facility case-mix. Clinical outcomes for matched cohorts were compared by standard methods. RESULTS: There were 23,831 records for patients who underwent laparoscopic cholecystectomy; 20,568 (86%) performed with the attending scrubbed, and 3,263 (14%) without the attending scrubbed. Over time there was a significant decrease in the proportion of cases without the attending scrubbed, 18% in 2004-2009 to 13% in 2015-2019 (p < 0.001). On PSM, 3,263 patients undergoing laparoscopic cholecystectomy by the residents without the attending scrubbed were successfully matched (1:1) to cases with the attending scrubbed. On comparison of matched cohorts, procedures performed without the attending scrubbed were statistically longer (102 vs 98 minutes, p = 0.001) but with no difference in rates of postoperative complications (5% vs 5%, p = 0.9). CONCLUSION: In comparison with cases done with more direct attending involvement, residents perform laparoscopic cholecystectomies efficiently without increased complications. Over time, attendings are more frequently scrubbed for the operation.


Asunto(s)
Colecistectomía Laparoscópica , Internado y Residencia , Cirujanos , Colecistectomía Laparoscópica/efectos adversos , Competencia Clínica , Humanos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Puntaje de Propensión
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