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1.
Artículo en Chino | MEDLINE | ID: mdl-33794627

RESUMEN

Objective:To analyze the causes and related factors of postoperative complications of Juvenile-onset recurrent respiratory papillomatosis(JORRP). Methods:One hundred and seventy cases of JORRP who underwent surgical treatment in Beijing Tongren Hospital of Capital Medical University from 2017 to 2019 were followed up, and the types of complications, age of first operation, number and frequency of operations, and underwent tracheotomy or not were reviewed. According to the presence or absence of postoperative complications, the patients were divided into a complication group and a control group, and the differences between the two groups and related factors causing postoperative complications were compared. Results:In the 170 cases, 75(44.12%) had postoperative complications, including 52(69.33%) cases of vocal cord adhesion, 37(49.33%) cases of lower airway diffusion, and 25(33.33%) cases of laryngeal stenosis in the complication group. The age of first operation was among 0.3-14 years old, and the total number of surgeries was 14.52(1-54) for each patient during the observation period, with an average annual number of 2.93(0.04-18.39). Compared with the control group, the complication group had 19.07±13.12 total surgeries, the control group had 10.97±9.41 surgeries(P<0.01), annual surgeries ≥4 times(P=0.034), postoperative complications after tracheotomy(P=0.007), and underwent low temperature plasma radiofrequency ablation and photodynamic therapy were more likely to occur than those treated with CO2laser only(P<0.01). Conclusion:The postoperative complications of JORRP include vocal cord adhesion, laryngotracheal stenosis, lower airway dissemination, etc. Multiple and frequent operations, tracheotomy, and different surgical methods are closely related to postoperative complications. The risk of postoperative complications may be increased when children are younger in age of initial operation and with more frequency of surgeries.


Asunto(s)
Infecciones por Papillomavirus , Infecciones del Sistema Respiratorio , Adolescente , Niño , Preescolar , Humanos , Lactante , Complicaciones Posoperatorias/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Estudios Retrospectivos
2.
Georgian Med News ; (311): 17-21, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33814383

RESUMEN

The objective and the goal of this study was to determine how ERAS guidelines affected on hospital stay days and other complications rates in case of elective colorectal surgery in our clinic, compared to traditional care methods. First of all, all team members including surgeons, anesthetists, nurses were being trained in ERAS guidelines principals during two months and we started active implementation process after this. 87 patients, who were needed to be done colorectal surgery treatment, were actively treated according to ERAS guidelines and these patients were gathered in experimental group. At the same time, we started to collect data retrospectively from last 2 years elective colorectal surgery cases and sorted them according to preoperative, intraoperative surgical and anesthesia data, postoperative analgesia, all type of complications. 120 patients were placed in traditional care group (control group). In traditional care group open colorectal surgery was associated with long length of stay 8-10 days. High rates of surgical site infection-24.2%, readmission rate during 30 days-30.8%, PONV-44.2%, respiratory complication-6.7%, deep vein thrombosis-3.3%, urinary retention-2.5%, prolonged postoperative ileus 16.7%. We included 87 patients in ERAS care group during 2 years. In this group our study showed big reduction of hospital stay days and it was average 5 days. Compared to traditional care group incidence of respiratory complications was 0, postoperative PONV- 6.9%, postoperative ileus-5.7%, deep vein thrombosis-0, urinary retention-0, readmission rate-0, surgical site infection-3.4%.


Asunto(s)
Cirugía Colorrectal , Procedimientos Quirúrgicos del Sistema Digestivo , Recuperación Mejorada Después de la Cirugía , Cirugía Colorrectal/efectos adversos , Procedimientos Quirúrgicos Electivos , Humanos , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos
3.
Bone Joint J ; 103-B(4): 635-643, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789473

RESUMEN

AIMS: Debate continues regarding the optimum management of periprosthetic distal femoral fractures (PDFFs). This study aims to determine which operative treatment is associated with the lowest perioperative morbidity and mortality when treating low (Su type II and III) PDFFs comparing lateral locking plate fixation (LLP-ORIF) or distal femoral arthroplasty (DFA). METHODS: This was a retrospective cohort study of 60 consecutive unilateral (PDFFs) of Su types II (40/60) and III (20/60) in patients aged ≥ 60 years: 33 underwent LLP-ORIF (mean age 81.3 years (SD 10.5), BMI 26.7 (SD 5.5); 29/33 female); and 27 underwent DFA (mean age 78.8 years (SD 8.3); BMI 26.7 (SD 6.6); 19/27 female). The primary outcome measure was reoperation. Secondary outcomes included perioperative complications, calculated blood loss, transfusion requirements, functional mobility status, length of acute hospital stay, discharge destination and mortality. Kaplan-Meier survival analysis was performed. Cox multivariate regression analysis was performed to identify risk factors for reoperation after LLP-ORIF. RESULTS: Follow-up was at mean 3.8 years (1.0 to 10.4). One-year mortality was 13% (8/60). Reoperation was more common following LLP-ORIF: 7/33 versus 0/27 (p = 0.008). Five-year survival for reoperation was significantly better following DFA; 100% compared to 70.8% (95% confidence interval (CI) 51.8% to 89.8%, p = 0.006). There was no difference for the endpoint mechanical failure (including radiological loosening); ORIF 74.5% (56.3 to 92.7), and DFA 78.2% (52.3 to 100, p = 0.182). Reoperation following LLP-ORIF was independently associated with medial comminution; hazard ratio (HR) 10.7 (1.45 to 79.5, p = 0.020). Anatomical reduction was protective against reoperation; HR 0.11 (0.013 to 0.96, p = 0.046). When inadequately fixed fractures were excluded, there was no difference in five-year survival for either reoperation (p = 0.156) or mechanical failure (p = 0.453). CONCLUSION: Absolute reoperation rates are higher following LLP fixation of low PDFFs compared to DFA. Where LLP-ORIF was well performed with augmentation of medial comminution, there was no difference in survival compared to DFA. Though necessary in very low fractures, DFA should be used with caution in patients with greater life expectancies due to the risk of longer term aseptic loosening. Cite this article: Bone Joint J 2021;103-B(4):635-643.


Asunto(s)
Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Periprotésicas/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera , Pérdida de Sangre Quirúrgica/prevención & control , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Placas Óseas , Femenino , Fracturas del Fémur/mortalidad , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Fracturas Periprotésicas/mortalidad , Complicaciones Posoperatorias/epidemiología , Falla de Prótesis , Recuperación de la Función , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia
4.
Bone Joint J ; 103-B(4): 659-664, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789480

RESUMEN

AIMS: Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). METHODS: The study included 42 consecutive hips in 42 patients (three male and 39 female) who underwent PAO from May 2016 to July 2018. We prospectively evaluated the incidence of LFCN injury at ten days, three months, six months, and one year postoperatively. We also evaluated the clinical scores, including the HHS, SF-36, and JHEQ scores, at one year postoperatively. RESULTS: LFCN injury was observed in 31 of 42 (74%) patients at ten days, of which 11 resolved completely by one year. Incidence decreased gradually, to 25 of 42 (60%) patients at three months, 24 of 42 patients (57%) at six months, and 20 of 42 (48%) patients at one year postoperatively. There was no significant difference in the HHS between patients with and without LFCN injury at one year postoperatively. Regarding the SF-36 and JHEQ, a significant difference in the mental score was recognized between patients with and without LFCN injury, but there were no significant differences in the other clinical scores. CONCLUSION: The incidence of LFCN injury was 74% at ten days after PAO, and subsequently decreased to 48% at one year. LFCN injury did not influence the hip function as assessed by the HHS, but had a negative impact on mental health at one year. Cite this article: Bone Joint J 2021;103-B(4):659-664.


Asunto(s)
Acetábulo/cirugía , Nervio Femoral/lesiones , Osteotomía , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios
5.
Bone Joint J ; 103-B(4): 696-703, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789488

RESUMEN

AIMS: We report the medium-term outcomes of a consecutive series of 118 Zenith total ankle arthroplasties (TAAs) from a single, non-designer centre. METHODS: Between December 2010 and May 2016, 118 consecutive Zenith prostheses were implanted in 114 patients. Demographic, clinical, and patient-reported outcome measures (PROMs) data were collected. The endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan-Meier survival curves were generated with 95% confidence intervals (CIs) and the rate of failure calculated for each year. RESULTS: Eight patients (ten ankles) died during follow-up, but none required revision. Of the surviving 106 patients (108 ankles: rheumatoid arthritis (RA), n = 15; osteoarthritis (OA), n = 93), 38 were women and 68 were men, with a mean age of 68.2 years (48 to 86) at the time of surgery. Mean follow-up was 5.1 years (2.1 to 9.0). A total of ten implants failed (8.5%), thus requiring revision. The implant survival at seven years, using revision as an endpoint, was 88.2% (95% CI 100% to 72.9%). There was a mean improvement in Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ) from 85.0 to 32.8 and visual analogue scale (VAS) scores from 7.0 to 3.2, and overall satisfaction was 89%. The three commonest complications were malleolar fracture (14.4%, n = 17), wound healing (13.6%, n = 16), and superficial infection (12.7%, n = 15). The commonest reason for revision was aseptic loosening. No patients in our study were revised for deep infection. CONCLUSION: Our results show that Zenith survival rates are comparable with those in the literature for other implants and in the National Joint Registry (NJR). Overall patient satisfaction was high as were functional outcomes. However, the data highlight potential complications associated with this surgery. The authors believe that these figures support ankle arthroplasty as an option in the treatment of ankle arthritis. Cite this article: Bone Joint J 2021;103-B(4):696-703.


Asunto(s)
Artroplastia de Reemplazo de Tobillo/métodos , Medición de Resultados Informados por el Paciente , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/cirugía , Femenino , Humanos , Prótesis Articulares , Masculino , Persona de Mediana Edad , Osteoartritis/cirugía , Complicaciones Posoperatorias/epidemiología , Falla de Prótesis , Reoperación/estadística & datos numéricos , Reino Unido/epidemiología
6.
Anticancer Res ; 41(4): 2197-2201, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813434

RESUMEN

BACKGROUND/AIM: To evaluate complications and risk factors associated with transumbilical incision as an organ removal site in laparoscopic pancreatectomy (LP). PATIENTS AND METHODS: In total, 52 patients who underwent LP between 2009 and 2017 were included in this study. The development of superficial surgical site infection (SSI) and transumbilical port-site incisional hernia was recorded. RESULTS: None of the patients had SSI. However, three (5.77%) presented with transumbilical incisional hernia. No variables were significantly associated with the risk of transumbilical incisional hernia. CONCLUSION: No evident risk factors correlated with hernia formation. Hence, incisional hernia might have occurred at a certain probability. In some cases, it was caused by technical problems. However, the use of transumbilical incision as an organ removal site was feasible, and a new incision for organ removal alone was not required.


Asunto(s)
Laparoscopía/métodos , Páncreas/patología , Pancreatectomía/métodos , Enfermedades Pancreáticas/cirugía , Ombligo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Hernia Incisional/diagnóstico , Hernia Incisional/epidemiología , Hernia Incisional/etiología , Japón/epidemiología , Laparoscopía/efectos adversos , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Páncreas/cirugía , Pancreatectomía/efectos adversos , Pancreatectomía/estadística & datos numéricos , Enfermedades Pancreáticas/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Manejo de Especímenes/efectos adversos , Manejo de Especímenes/métodos , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Ombligo/patología , Adulto Joven
7.
Kyobu Geka ; 74(4): 297-303, 2021 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-33831890

RESUMEN

OBJECTIVES: Total arch replacement( TAR) is used to be a complicated and quite invasive aortic procedure. To perform TAR safely and effectively under all circumstances, we have constructed standardization of the procedures of TAR. The aim of this study is to analyze the impact of surgeons' experience on surgical outcome of TAR to evaluate our standardization. METHODS: From January 2008 to December 2020, 346 consecutive patients (mean age 73.6±10.2) underwent elective TAR through a median sternotomy at our institute. TAR was performed by three types of surgeon classified by their experience( A:over 20 years, B:15~20 years, C:under 15 years). The surgical outcomes were examined. Our standard approach include( 1) meticulous selection of arterial cannulation site and type of arterial cannula;(2) antegrade selective cerebral perfusion;(3) maintenance of minimal tympanic temperature between 20 ℃ and 23 ℃;(4) early rewarming just after distal anastomosis;(5) maintaining fluid balance below 1,000 ml during cardiopulmonary bypass. RESULTS: The operative cases were 227 in A, 86 in B and 33 in C. Surgeon A operated more complicated TAR with higher operative risk compared with B and C. The hospital mortality and major complication rate was not significant difference among surgeons( hospital mortality A:3.5%, B:2.3%, C:3.0%). Multivariate analysis showed the surgeons' experience was not associated with hospital mortality and major complications. Long-term outcomes were also compatible among three groups. CONCLUSIONS: Our standardization for TAR seemed to be an useful approach to eliminate the impact of surgeon experience on surgical outcomes if the type of surgeon was appropriately selected according to the level of operative difficulty.


Asunto(s)
Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Cirujanos , Anciano , Anciano de 80 o más Años , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Procedimientos Quirúrgicos Electivos , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento
8.
Artículo en Chino | MEDLINE | ID: mdl-33832194

RESUMEN

Objective: To discuss the complications and postoperative outcomes of tracheotomy with different etiology in children. Methods: One hundred and eighty-six patients underwent tracheotomy were retrospectively analyzed from January 2016 to December 2018,including 117 males and 69 females. The children aged from 4 days to 14 years (median age 31.5months). One case was operated under local anesthesia in emergency room, 2 cases were operated under local anesthesia in pediatric intensive care unit, the rest 183 cases were operated under general anesthesia in operation room. The 186 children were divided into four groups according to their direct causes of tracheotomy. Group A(90 cases): Neuromuscular disease and severe infection,Group B(26 cases): Head and neck tumor,Group C(57 cases): Congenital malformation and upper airway obstruction,Group D(13 cases): Accidental injury. The basic information, surgical complications and postoperative outcomes were recorded and analyzed. All patients were followed up by clinic or by telephone. Spss 19.0 software was used for statistical analysis. Results: One hundred and eighty-six patients were followed up for one to four years. 33 children lost the follow-up and 46 died. Among the 186 patients, 23 cases had emergency tracheotomy (12.4%). The rate of emergency tracheotomy in group C(16 cases, 28.1%) was higher than that in the other three groups(χ2=28.08,P<0.05). The average age of patients and hospital stay in group C were significantly lower than those in the other three groups (F=33.76,P<0.05; F=14.95,P<0.05). Incision bleeding occurred in 11 cases, Subcutaneous emphysema occurred in 6 cases and accidental decannulation occurred in 10 cases (4 cases within 2 weeks and 6 after 2 weeks). Six patients underwent tracheocutaneous fistula closure operation after decannulation and the stoma healed spontaneously in other extubated children. Two patients underwent secondary tracheotomy due to accidental decannulation, and three patients underwent secondary tracheotomy for dyspnea after decannulation. In 107 cases of survival children, decannulation was successful in 65 patients and failed in 42 patients. The average duration of wearing tracheal tube was 8.8 months. The decannulation rates in the four groups were 55.6%, 45%, 69% and 77.8%, with no significant difference. Conclusions: The complications after tracheotomy in children are rare, and no severe complications occurred in long-term tracheotomy patients. The duration of wearing tracheal tube is related to the treatment of their primary disease.


Asunto(s)
Complicaciones Posoperatorias , Traqueotomía , Adulto , Anciano , Anestesia General , Niño , Femenino , Humanos , Lactante , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Traqueostomía , Traqueotomía/efectos adversos
9.
Rev Port Cir Cardiotorac Vasc ; 28(1): 19-23, 2021 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-33834657

RESUMEN

OBJECTIVES: Our objective was to examine the results of ECMO post cardiotomy in Centro Hospitalar Universitário S. João (CHUSJ). METHODS: Between 2011 and 2019, 13 patients were cannulated for refractory cardiogenic shock post-cardiotomy; 8 (61,5%) male and 5 (38,5%) female. Patients under 18 years old were excluded. Data was collected from hospital archives concerning preoperative comorbidities, open-heart surgery procedure, dates of ECMO cannulation and decannulation, postoperative complications, hospital mortality and cause of death. Follow-up was obtained by review of the last outpatient observation. The outcomes investigated were hospital mortality and survival at 12, 36 and 60 months. RESULTS: After a median ECMO-VA therapy of 6 days (1-16 days), 7 (53,8%) patients were successfully decannulated; from these 2 succumbed from stroke and septic shock, one is still in intermediate care convalescing steadily and 4 were discharged. Overall 8 (61,5%) patients died. 5 (38,5%) survived, 4 were discharged home and 1 is still in intermediate care. Survival (after discharge) at 12, 36 and 60 months was respectively 25%, 16,7% and 8,3%. Regarding postoperative complications, reoperation for bleeding was necessary in 5 (38.5%), stroke was diagnosed in 2 (15,4%), dialysis in 6 (46,2%), leg ischemia affected 5 (38,5%) and mediastinitis occurred in 1 (7,7%). CONCLUSIONS: VA ECMO saves a life in each three patients suffering from refractory cardiogenic shock after cardiac surgery. Despite risks associated with advanced cardiopulmonary support, survivors maintain good health condition.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Oxigenación por Membrana Extracorpórea , Adolescente , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Femenino , Humanos , Masculino , Pericardiectomía , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia
10.
Artículo en Ruso | MEDLINE | ID: mdl-33834714

RESUMEN

OBJECTIVE: To estimate the frequency of early postoperative neurological complications in patients undergoing planned surgery on the ascending aortic and arch of the aorta, and their long-term outcomes. MATERIAL AND METHODS: The prospective study included 100 patients who were operated on at the FSBSI Petrovsky Russian Research Center of Surgery. In group I (n=50), operations were performed on the aortic arch with hypothermic circulatory arrest (26 °C) and antegrade cerebral perfusion. Patients in group II underwent prosthetics of the ascending aorta with extracorporeal circulation and moderate hypothermia (32 °C). All patients underwent monitoring of cerebral and tissue oxygenation, transcranial Doppler and testing of cognitive functions before and after surgery, and after 5 and 10 years of follow-up. RESULTS: Postoperative stroke in group I was observed in 1 (2%) patient, no cases were observed in group II. Delirium was detected in 14% of patients in group I and 6% of patients in group II, its subsyndromal form was found in 6 and 4%, respectively. Moderate cognitive impairment in the immediate postoperative period was found in 42 and 26%; severe in 8% of group I. After 5 years of follow-up, the number of patients with moderate and severe cognitive impairment was 23.1 and 12.8%, respectively. After 10 years, severe disorders were identified in 37.5 and 21.9% of patients. CONCLUSION: In cardiac surgery patients, intraoperative multimodal monitoring allows dynamic regulation of antegrade cerebral perfusion. Dynamic testing of cognitive functions and early detection of delirium in the immediate postoperative period improve long-term neurological treatment outcomes.


Asunto(s)
Aorta Torácica , Aorta , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Circulación Cerebrovascular , Humanos , Perfusión , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Federación de Rusia , Resultado del Tratamiento
11.
Mymensingh Med J ; 30(2): 453-457, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33830128

RESUMEN

Ventral hernia after abdominal surgery is a common complication. Several techniques for the repair of ventral hernia have been described from time to time and it is a great challenge for a surgeon. The mesh placement by sublay technique authorized by Rives and Stoppa in Europe has been reported to be effective with low recurrence rate. The objective of this study was to evaluate the efficacy of sublay technique of mesh placement in ventral hernia. This prospective study was carried out in the Department of Surgery, Dhaka Dental College, Bangladesh from January 2017 to December 2018. A total of 21 patients with ventral hernia were included in this study. Data collected in data collection sheet regarding demographic data, severity of symptoms and post operative complains of patients which were then analyzed. Age ranged from 21-60 years. Male were 5(23.80%) and female were 16(76.20%). Dragging pain were 7(33.33%), irreducibility were 4(19.05%) but swelling were 100%. Incisional hernia was 18(85.71%) and para-umbilical hernia was 3(14.29%). Post-operative complication were seroma1 (4.76%), major wound infection 1(4.76%), minor infection 1(4.76%) but no recurrence. Sublay mesh repair in ventral hernia was found to be a better and effective technique with minimal complication rate.


Asunto(s)
Hernia Ventral , Mallas Quirúrgicas , Adulto , Bangladesh , Femenino , Hernia Ventral/cirugía , Herniorrafia , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Recurrencia , Resultado del Tratamiento , Adulto Joven
12.
Medicine (Baltimore) ; 100(12): e25274, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761730

RESUMEN

ABSTRACT: To investigate the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fractures and to construct a risk assessment model.Based on the multicenter retrospective analysis of 251 patients, all patients were divided into modeling group and verification group. In the modeling group, postoperative fracture nonunion rate, general data, fracture-related factors, surgical reduction-related factors, mechanical and biological factors were calculated, and the influencing factors of fracture nonunion were screened by univariate analysis. Logistic regression model was used for multifactor analysis to construct the risk assessment model. Based on the logistic regression model, the risk prediction model was constructed by drawing the Nomogram diagram. Through the verification group, the influencing factors were evaluated again, and the differentiation and calibration of the model were evaluated. The calibration degree was evaluated by Hosmer-Lemeshow test, goodness of fit test, and calibration curve. The discriminant degree was evaluated by the receiver operating characteristic curve.Fracture nonunion occurred in 34 of 149 patients in the modeling group. Among the 14 potential influencing factors, univariate analysis and logistic regression analysis showed that postoperative hip varus, intramedullary nail fixation failure, and reduction of fracture with large incision were the risk factors of fracture nonunion. The medial cortex fracture was seen reduced on X-Ray was a protective factor for fracture nonunion, and a regression equation was established. Based on the logistic regression model, the Nomogram diagram is drawn. Twenty-four cases of fracture nonunion occurred in the verification group. The area under the receiver operating characteristic curve was area under curve =0.883 > 0.7, indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation. The goodness of fit test: the Hosmers-Lemeshow test (X2 = 2.921, P = .712 > .05) showed that the model had a good calibration.After intramedullary nailing of subtrochanteric fracture, hip varus, failure of intramedullary nail fixation and wide surgical dissection are the risk factors of fracture nonunion, and the postoperative reduction of medial cortex fracture is protective factor.National key research and development projects: 2016YFC0105806.


Asunto(s)
Coxa Vara , Fijación Intramedular de Fracturas , Fracturas no Consolidadas , Fracturas de Cadera/cirugía , Complicaciones Posoperatorias , Medición de Riesgo , Anciano , Clavos Ortopédicos , Coxa Vara/diagnóstico , Coxa Vara/epidemiología , Femenino , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fracturas no Consolidadas/diagnóstico , Fracturas no Consolidadas/epidemiología , Fracturas no Consolidadas/etiología , Fracturas de Cadera/diagnóstico , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/epidemiología , Masculino , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Radiografía/métodos , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Insuficiencia del Tratamiento
13.
J Laryngol Otol ; 135(3): 229-233, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641683

RESUMEN

OBJECTIVE: To determine the incidence of nasolacrimal duct injury after functional endoscopic sinus surgery radiologically, using computed tomography. METHODS: Fifty patients of either sex who underwent functional endoscopic sinus surgery were evaluated for nasolacrimal duct injury by computed tomography. Computed tomography was conducted pre-operatively, and post-operatively at the end of four weeks, and nasolacrimal duct injury was analysed. RESULTS: The prevalence of nasolacrimal duct injury dehiscence was 1.16 per cent, with a similar incidence of 1.16 per cent for nasolacrimal duct injury post-operatively. However, no cases of symptomatic nasolacrimal duct injury were recorded. CONCLUSION: Computed tomography scan is an effective, non-invasive method to evaluate nasolacrimal duct injury following functional endoscopic sinus surgery, in accordance with evidence-based medicine.


Asunto(s)
Endoscopía/efectos adversos , Aparato Lagrimal/lesiones , Senos Paranasales/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Enfermedad Crónica , Femenino , Humanos , Incidencia , Aparato Lagrimal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Prevalencia , Estudios Prospectivos , Rinitis/cirugía , Sinusitis/cirugía , Adulto Joven
15.
Medicine (Baltimore) ; 100(12): e25151, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761684

RESUMEN

ABSTRACT: In 2014, the American College of Cardiology/American Heart Association (ACC/AHA) released guidelines for ordering pre-operative echocardiograms in patients undergoing non-cardiac surgery. The purpose of this study is to determine if pre-operative echocardiograms ordered prior to fragility hip fracture repair are ordered according to these guidelines, change anesthetic management or affect patient outcomes. In addition, we attempted to evaluate the efficacy of the ACC/AHA guidelines.We conducted a 4-year retrospective chart review of acute fragility hip fractures at a single institution. Charts were reviewed to determine which patients met criteria for a pre-operative echocardiogram. Within this group we then compared patients who received a pre-operative echocardiogram to those who did not. Comparisons were made with regard to time to surgery, changes from standard anesthetic management, major adverse cardiac events, length of hospital stay, and 1-year mortality. We also examined which patients received postoperative echocardiograms and the incidence of adverse cardiac events in this group.Of 402 patients, 87 (22%) had ACC/AHA indications for pre-operative echocardiogram, and 42 (48%) of them received one. The indication to order a pre-operative echocardiogram in stable heart failure or valve disease patients if their last echo was greater than 1 year was only followed 23% of the time. In the pre-operative echocardiogram group, anesthetic management was adjusted more frequently (P = .025), and average time to surgery was greater (P < .001). The incidence of a major adverse cardiac event was 10% in the ACC/AHA echocardiogram indicated group and 3% in the non-indicated echocardiogram group. An equal number of echocardiograms were completed postoperatively as were completed under ACC/AHA pre-operative guidelines. Sixty-seven percent of the postoperative echocardiograms did not have ACC/AHA pre-operative indications.Our data demonstrates that pre-operative echocardiograms for "stable heart failure and valvular disease with greater than 1 year from last echocardiogram" is infrequently performed without significant adverse cardiac outcomes. Pre-operative echocardiography was associated with more anesthetic adjustments and longer time to surgery. Postoperative echocardiograms were done for cardiopulmonary complications. Studies need to examine and refine clinical parameters that would improve the selection of patients who would benefit from pre-operative echocardiograms.


Asunto(s)
Ecocardiografía/normas , Cardiopatías/prevención & control , Fracturas de Cadera/diagnóstico por imagen , Fracturas Osteoporóticas/diagnóstico por imagen , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/normas , Anciano de 80 o más Años , Femenino , Fijación de Fractura/efectos adversos , Fijación de Fractura/normas , Adhesión a Directriz/estadística & datos numéricos , Cardiopatías/epidemiología , Cardiopatías/etiología , Fracturas de Cadera/cirugía , Humanos , Incidencia , Masculino , Fracturas Osteoporóticas/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Medición de Riesgo
16.
Medicine (Baltimore) ; 100(9): e24166, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655910

RESUMEN

BACKGROUND: The purpose of this meta-analysis was to evaluate the clinical efficacy and safety of HR and PFNA in the treatment of intertrochanteric fractures in the elderly. METHODS: We carried out this review according to the principle of preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline. The clinical randomized controlled trials (RCTs), prospective cohort studies, retrospective cohort studies (RCSs), and case-control studies involving HR and PFNA in the treatment of intertrochanteric fractures in the elderly from 2000 to 2020 were compared by searching Web of Science, Pubmed, the Cochrane Library, and Embase. The quality of the included cohort study (CS) lines was evaluated using the Newcastle-Ottawa Scale (NOS). The quality of the included RCT lines was evaluated using Jadad. Forest plots were drawn by RevMan5.4 software based on the results and the data were analyzed. RESULTS: After screening, a total of 9 articles were included, of which one was a clinical RCT and eight were RCSs with 1374 patients. The operative time of the PFNA group was shorter [WMD = 15.20; 95% CI (13.17, 17.23), P < .05] and the intraoperative blood loss was less [WMD = 178.81; 95% CI (97.24, 260.38), P < .05] than the HR group, while the first weight-bearing time of the HR group was shorter [WMD = -7.70; 95% CI (-10.54, -4.86), P  < .05] than the PFNA group. There was no significant difference in the length of hospital stay, HHS, postoperative orthopedic complications, and postoperative medical complications between the 2 groups. CONCLUSION: With the development of HR technology and minimally invasive technology, the trauma caused by surgery is decreasing. Under the premise of improving perioperative management, such as optimizing the preoperative preparation and postoperative management, shortening the operative time, reducing intraoperative blood loss, and actively managing co-existing diseases, HR has more advantages than PFNA in the treatment of senile intertrochanteric fractures.


Asunto(s)
Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Clavos Ortopédicos , Fijación Interna de Fracturas/estadística & datos numéricos , Fracturas de Cadera/cirugía , Anciano , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Resultado del Tratamiento
17.
Int Heart J ; 62(2): 305-311, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33731528

RESUMEN

Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI). Although previous studies have investigated mortality rates and the incidences of adverse events associated with new-onset AF (NOAF) in patients with AMI, the effects of emergency percutaneous coronary intervention (PCI) on the incidence of NOAF in patients with AMI remain unclear. The purpose of this study was to investigate the relationship of clinical characteristics, medical history, and the coronary flow disturbance phenomenon (TIMI < 3) following emergency PCI with NOAF in patients with AMI. Between 2012 and 2016, 731 patients with AMI underwent PCI at our facility. Among these, 52 had a history of chronic/paroxysmal AF before admission and were excluded. The remaining 679 patients (mean age 66.4 years, 532 males) were analyzed in this retrospective observational study.New-onset AF was observed in 45 patients (6.6%). In univariate analysis, the hazard ratios (HRs) for patient age (HR 1.04, 95%CI 1.02-1.07), Killip II-IV (HR 2.34, 95%CI 1.29-4.23), elevated D-dimer level (> 1.0 µg/mL; HR 3.32; 95%CI 1.77-6.23), and coronary flow disturbance phenomenon (HR 5.61; 95%CI 2.88-10.9) were significantly higher in the NOAF group. In multivariate analysis, an elevated D-dimer level (> 1.0 µg/mL; HR 2.44; 95%CI 1.17-5.11) and coronary flow disturbance phenomenon (HR 4.61; 95%CI 2.29-9.27) were found to be independent risk factors for NOAF. An elevated D-dimer level at admission and the presence of coronary flow disturbance phenomenon after PCI were risk factors for NOAF following emergency PCI in patients with AMI.


Asunto(s)
Fibrilación Atrial/fisiopatología , Circulación Coronaria/fisiología , Vasos Coronarios/fisiopatología , Infarto del Miocardio/cirugía , Intervención Coronaria Percutánea , Complicaciones Posoperatorias/fisiopatología , Anciano , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos
18.
Ann R Coll Surg Engl ; 103(4): 278-281, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682450

RESUMEN

INTRODUCTION: Microvascular reconstruction is the gold standard for reconstruction in oral cavity cancers. Age and comorbidities determine the type of reconstruction. We aimed to analyse the impact of high-risk comorbidities on perioperative morbidity. METHODS: This is a retrospective study of 317 patients undergoing microvascular reconstruction from January 2014 to December 2017. High risk patients were based on age, American Society of Anaesthesiologists (ASA) grade (III/IV) and Charlson comorbidity index (CCI) score >4; overall, 73 out of 317 patients were evaluated. RESULTS: Median age was 59 years. Five patients (6.8%) had complete flap failures and seven (9.5%) had minor complications (wound breakdown, bleeding, wound dehiscence, partial flap loss). ASA score of IV was significantly associated with morbidity while age >65 years and CCI >4 was not associated. The overall flap success rate was 93.2%. CONCLUSIONS: A high-risk population has nearly similar outcomes for microvascular reconstruction as a younger age group. High ASA score adversely affects surgery-related outcomes.


Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Microcirugia/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Carcinoma de Células Escamosas de Cabeza y Cuello/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Colgajos Quirúrgicos , Resultado del Tratamiento
19.
Ann R Coll Surg Engl ; 103(4): 255-262, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682461

RESUMEN

INTRODUCTION: Laparoscopic adhesiolysis is increasingly being used to treat adhesional small bowel obstruction (ASBO) as it has been associated with reduced postoperative length of stay (LOS) and faster recovery. However, concerns regarding limited working space, iatrogenic bowel injury and failure to relieve the obstruction have limited its uptake. This study reports our centre's experience of adopting laparoscopy as the standard operative approach. METHODS: A single-centre prospective cohort study was performed incorporating local data from the National Emergency Laparotomy Audit Database; January 2015 to December 2019. All patients undergoing surgery for ASBO were included. Patient demographic, operative and inhospital outcomes data were compared between different surgical approaches. Linear regression analysis was performed for LOS. RESULTS: A total of 299 cases were identified. Overall, 76.3% of cases were started laparoscopically and 52.2% were completed successfully. Patients treated laparoscopically had lower Portsmouth - Physiological and Operative Severity Score for the enuMeration of Mortality and morbidity (P-POSSUM) predicted mortality (median 2.1 (interquartile range (IQR) 1.3-5.0) vs 5.7 (IQR 2.0-12.4), p=<0.001) and shorter postoperative LOS compared with open (median 4.2 days (IQR 2.5-8.2) vs 11.3 days (IQR 7.3-16.6), p=0.000). Inhospital mortality was lower in the laparoscopic group (2 vs 7 deaths, p=<0.001). In regression analysis, laparoscopic surgery was found to have the strongest association with postoperative LOS (ß -8.51 (-13.87 to -3.16) p=0.002) compared with open surgery. CONCLUSIONS: Laparoscopy is a safe and feasible approach for adhesiolysis in the majority of patients with ASBO. It is associated with reduced LOS with no impact on complications or mortality.


Asunto(s)
Obstrucción Intestinal/cirugía , Intestino Delgado/cirugía , Laparoscopía , Adherencias Tisulares/cirugía , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Urgencias Médicas , Femenino , Mortalidad Hospitalaria , Humanos , Obstrucción Intestinal/etiología , Tiempo de Internación/estadística & datos numéricos , Modelos Lineales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Adherencias Tisulares/complicaciones , Resultado del Tratamiento
20.
Artículo en Ruso | MEDLINE | ID: mdl-33728846

RESUMEN

OBJECTIVE: A special place among cognitive disorders in patients with cardiovascular diseases is given to postoperative cognitive dysfunction (POCD). The study aimed at investigating the patterns of beta-2 activity associated with postoperative cognitive dysfunction (POCD) in patients after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: The study included 60 patients who underwent neuropsychological testing 3-5 days before surgery and on the 7-10th day of CABG. A multichannel electroencephalogram of resting state with eyes closed in 62 standard leads was recorded. Statistical processing of the results was carried out using Statistica 10 (StatSoft Inc, USA) and the developed method of data clustering with a minimax criterion, a software implementation of the binary clipping and branching algorithm was used to find optimal solutions. RESULTS: Patients with POCD had higher pre- and postoperative high-frequency beta-2 rhythm power (20-30 Hz) compared with patients without cognitive impairment. The regression model demonstrated that POCD was associated with high values of preoperative beta-2 activity in the right frontal cortex and with low values in the left parietal areas after CABG. The clustering of beta-2 rhythm power before and after CABG revealed that the best cognitive status corresponded to a stable affiliation of patients with the selected clusters. CONCLUSION: The specific POCD correlates were established in patients after CABG. Low cognitive status was characterized by the preoperative beta-2 power increase in the right frontal areas and postoperative decrease in the left parietal cortex. The developed method for classifying patients according to the level of pre- and postoperative beta-2 rhythm power has a good discriminant ability. Stable patient affiliation with the selected clusters was associated with a higher level of cognitive status.


Asunto(s)
Trastornos del Conocimiento , Disfunción Cognitiva , Cognición , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Disfunción Cognitiva/etiología , Puente de Arteria Coronaria , Humanos , Incidencia , Pruebas Neuropsicológicas , Complicaciones Posoperatorias/epidemiología
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