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1.
Medicine (Baltimore) ; 99(19): e19982, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384450

RESUMEN

Unplanned reoperations have not been studied extensively in pediatric patients, especially concerning risk factors. We aim to estimate the rate of unplanned reoperations and to determine the associated factors in pediatric general surgical specialties.This analysis included a retrospective case-control study of unplanned reoperations from July 1, 2010 to June 30, 2017 in the general surgical specialties. For each case, we identified approximately 2 randomly selected controls who underwent the same type of operation. The factors involved in the unplanned reoperations were investigated using univariate and multivariate analysis.Of the 3263 patients who underwent surgery, unplanned reoperations were performed in 139 patients (4.3%). The main indications for unplanned reoperations were wound complications (n = 52, 42.6%), followed by postoperative ileus (n = 12, 9.8%), postoperative bleeding (n = 8, 6.6%), and intraabdominal infection (n = 13, 10.7%). Following multivariate analysis, 2 factors remained significantly associated with unplanned reoperation: higher initial surgery-related risk level (P = .007, risk ratio (RR) = 0.48; 95% confidence interval (CI) = 0.27-0.82) and operation performed outside working hours (P = .031, RR = 0.52; 95% CI = 0.30-0.89).Various patient- and procedure-related factors were associated with unplanned reoperations. This information might be helpful for the optimization of treatment planning and resource allocation.


Asunto(s)
Complicaciones Posoperatorias/cirugía , Indicadores de Calidad de la Atención de Salud , Reoperación , Procedimientos Quirúrgicos Operativos/efectos adversos , Estudios de Casos y Controles , Preescolar , China/epidemiología , Femenino , Humanos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad , Reoperación/métodos , Reoperación/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos
2.
Medicine (Baltimore) ; 99(19): e20018, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384460

RESUMEN

BACKGROUND: Parkinson disease (PD) is a progressive neuromuscular disease associated with bradykinesia, tremor, and postural instability. We aimed to compare outcomes and complications of total hip arthroplasty (THA) between patients with PD and those without. METHODS: A single institution retrospective cohort from 2000 to 2018 was reviewed. PD patients were matched 1:2 with non-PD control patients for age, gender, American Society of Anesthesiologists score, and body mass index using a propensity score matching procedure. The primary outcome measures were postoperative complications and revision between PD and cohort groups. Secondary outcome measures were Harris Hip Score, hip range of motion, patient satisfaction, and surgery time. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort. RESULTS: Using prospectively collated data, we identified 35 PD patients after primary THA. A control cohort of 70 primary THA patients was matched. CONCLUSION: Our hypothesis was that PD would have adverse impact on complication rates, range of movement, or improvement in functional outcome after subsequent THA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5446).


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Osteoartritis de la Cadera , Enfermedad de Parkinson/complicaciones , Complicaciones Posoperatorias , Recuperación de la Función , Reoperación , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Casos y Controles , Protocolos Clínicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/cirugía , Evaluación de Resultado en la Atención de Salud , Prioridad del Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Rango del Movimiento Articular , Reoperación/métodos , Reoperación/estadística & datos numéricos
3.
Bone Joint J ; 102-B(4): 470-477, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228076

RESUMEN

AIMS: Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. METHODS: We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function. RESULTS: The union rate for Group A was 81% (17/21) while it was 84.6% (33/39) for Group B. All the nonunions in Group A underwent revision with an open technique and achieved 100% union. Mean duration of IRF was 71.5 days (59 to 82) in Group A and 69 days (64.8 to 77.7) in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was similar in both groups. The postoperative hospital stay was shorter in Group A (21 days (SD 8)) than Group B (28 days (SD 9)). In the latter Group there were more problems with wound healing and greater requirement for antibiotic treatment. The mean operating time was 40 minutes (SD 9) in Group A compared to 80 minutes (SD 13) in Group B. Recurrence of infection occurred in 19% (4/21) and 15.5% (6/39) for Group A and Group B respectively. CONCLUSION: We found CAA using an IRF to be an effective method for ankle arthrodesis in infected neuropathic foot and ankle cases and afforded comparable results to open methods. Due to its great advantages, Ilizarov method of CAA should always be considered for neuropathic ankles in suitable patients. Cite this article: Bone Joint J 2020;102-B(4):470-477.


Asunto(s)
Articulación del Tobillo/cirugía , Artritis Infecciosa/cirugía , Artrodesis/métodos , Artropatía Neurógena/cirugía , Técnica de Ilizarov , Deformidades Adquiridas de la Articulación/cirugía , Adulto , Anciano , Articulación del Tobillo/diagnóstico por imagen , Artritis Infecciosa/diagnóstico por imagen , Artrodesis/instrumentación , Artropatía Neurógena/diagnóstico por imagen , Enfermedad de Charcot-Marie-Tooth/diagnóstico por imagen , Enfermedad de Charcot-Marie-Tooth/cirugía , Femenino , Deformidades Adquiridas del Pie/diagnóstico por imagen , Deformidades Adquiridas del Pie/cirugía , Humanos , Deformidades Adquiridas de la Articulación/diagnóstico por imagen , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Osteomielitis/cirugía , Radiografía , Recurrencia , Reoperación/métodos , Estudios Retrospectivos , Factores de Tiempo , Cicatrización de Heridas
4.
Bone Joint J ; 102-B(4): 458-462, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228079

RESUMEN

AIMS: Varus-valgus constrained (VVC) implants are often used during revision total knee arthroplasty (TKA) to gain coronal plane stability. However, the increased mechanical torque applied to the bone-cement interface theoretically increases the risk of aseptic loosening. We assessed mid-term survivorship, complications, and clinical outcomes of a fixed-bearing VVC device in revision TKAs. METHODS: A total of 416 consecutive revision TKAs (398 patients) were performed at our institution using a single fixed-bearing VVC TKA from 2007 to 2015. Mean age was 64 years (33 to 88) with 50% male (199). Index revision TKA diagnoses were: instability (n = 122, 29%), aseptic loosening (n = 105, 25%), and prosthetic joint infection (PJI) (n = 97, 23%). All devices were cemented on the epiphyseal surfaces. Femoral stems were used in 97% (n = 402) of cases, tibial stems in 95% (n = 394) of cases; all were cemented. In total, 93% (n = 389) of cases required a stemmed femoral and tibial component. Femoral cones were used in 29%, and tibial cones in 40%. Survivorship was assessed via competing risk analysis; clinical outcomes were determined using Knee Society Scores (KSSs) and range of movement (ROM). Mean follow-up was four years (2 to 10). RESULTS: The five-year cumulative incidence of subsequent revision for aseptic loosening and instability were 2% (95% confidence interval (CI) 0.2 to 3, number at risk = 154) and 4% (95% CI 2 to 6, number at risk = 153), respectively. The five-year cumulative incidence of any subsequent revision was 14% (95% CI 10 to 18, number at risk = 150). Reasons for subsequent revision included PJI (n = 23, of whom 12 had previous PJI), instability (n = 13), and aseptic loosening (n = 11). The use of this implant without stems was found to be a significant risk factor for subsequent revision (hazard ratio (HR) 7.58 (95% CI 3.98 to 16.03); p = 0.007). KSS improved from 46 preoperatively to 81 at latest follow-up (p < 0.001). ROM improved from 96° prerevision to 108° at latest follow-up (p = 0.016). CONCLUSION: The cumulative incidence of subsequent revision for aseptic loosening and instability was very low at five years with this fixed-bearing VVC implant in revision TKAs. Routine use of cemented and stemmed components with targeted use of metaphyseal cones likely contributed to this low rate of aseptic loosening. Cite this article: Bone Joint J 2020;102-B(4):458-462.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/instrumentación , Cementación/métodos , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/etiología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Falla de Prótesis/etiología , Infecciones Relacionadas con Prótesis/etiología , Rango del Movimiento Articular , Recuperación de la Función , Reoperación/métodos , Factores de Riesgo , Resultado del Tratamiento
5.
Bone Joint J ; 102-B(4): 423-425, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228082

RESUMEN

AIMS: Dislocation remains a significant complication after total hip arthroplasty (THA), being the third leading indication for revision. We present a series of acetabular revision using a dual mobility cup (DMC) and compare this with our previous series using the posterior lip augmentation device (PLAD). METHODS: A retrospective review of patients treated with either a DMC or PLAD for dislocation in patients with a Charnley THA was performed. They were identified using electronic patient records (EPR). EPR data and radiographs were evaluated to determine operating time, length of stay, and the incidence of complications and recurrent dislocation postoperatively. RESULTS: A total of 28 patients underwent revision using a DMC for dislocation following Charnley THA between 2013 and 2017. The rate of recurrent dislocation and overall complications were compared with those of a previous series of 54 patients who underwent revision for dislocation using a PLAD, between 2007 and 2013. There was no statistically significant difference in the mean distribution of sex or age between the groups. The mean operating time was 71 mins (45 to 113) for DMCs and 43 mins (21 to 84) for PLADs (p = 0.001). There were no redislocations or revisions in the DMC group at a mean follow-up of 55 months (21 to 76), compared with our previous series of PLAD which had a redislocation rate of 16% (n = 9) and an overall revision rate of 25% (n = 14, p = 0.001) at a mean follow-up of 86 months (45 to 128). CONCLUSION: These results indicate that DMC outperforms PLAD as a treatment for dislocation in patients with a Charnley THA. This should therefore be the preferred form of treatment for these patients despite a slightly longer operating time. Work is currently ongoing to review outcomes of DMC over a longer follow-up period. PLAD should be used with caution in this patient group with preference given to acetabular revision to DMC. Cite this article: Bone Joint J 2020;102-B(4):423-425.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Luxación de la Cadera/cirugía , Prótesis de Cadera , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Registros Electrónicos de Salud , Femenino , Luxación de la Cadera/etiología , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Diseño de Prótesis , Falla de Prótesis/etiología , Reoperación/métodos , Estudios Retrospectivos
6.
Am Surg ; 86(3): 250-255, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32223806

RESUMEN

Roux-en-Y gastric bypass (RYGB) has been explored as a revisional option to failed paraesophageal hernia (PEH) repair with fundoplication, particularly in patients suffering from obesity. However, few studies have assessed long-term outcomes of RYGB with revisional PEH repair in regard to acid-suppressing medication use. We retrospectively identified 19 patients who underwent revisional PEH repair with RYGB between 2011 and 2018. The median operative time was 232 minutes with a median hospital length of stay of two days. The median length of follow-up was 24 months. Two patients (10.5%) had complications in the first 30 days, and five patients (26.3%) had complications within one year. Of the 12 patients on preoperative acid suppression, 6 (50%) were either off medication or on reduced dose at 12 months. The median BMI decrease was 14.4 kg/m² at 12 months and did not change significantly afterward. Although rates of acid-suppression medication use did not change overall after revisional PEH repair with RYGB, patients experienced successful long-term management of morbid obesity and sustained weight loss. Revisional PEH repair with RYGB is a safe and effective option, with a complication rate comparable with the reported rates after revisional foregut procedures such as revisional Nissen fundoplication.


Asunto(s)
Fundoplicación/efectos adversos , Derivación Gástrica/métodos , Hernia Hiatal/cirugía , Herniorrafia/efectos adversos , Reoperación/métodos , Adulto , Estudios de Cohortes , Femenino , Fundoplicación/métodos , Hernia Hiatal/diagnóstico , Herniorrafia/métodos , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Seguridad del Paciente , Pronóstico , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
7.
Isr Med Assoc J ; 22(4): 244-248, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32286029

RESUMEN

BACKGROUND: Pancreatic injuries during nephrectomy are rare, despite the relatively close anatomic relation between the kidneys and the pancreas. The data regarding the incidence and outcome of pancreatic injuries are scarce. OBJECTIVES: To assess the frequency and the clinical significance of pancreatic injuries during nephrectomy. METHODS: A retrospective analysis was conducted of all patients who underwent nephrectomy over a period of 30 years (1987-2016) in a large tertiary medical center. Demographic, clinical, and surgical data were collected and analyzed. RESULTS: A total of 1674 patients underwent nephrectomy during the study period. Of those, 553 (33%) and 294 patients (17.5%) underwent left nephrectomy and radical left nephrectomy, respectively. Among those, four patients (0.2% of the total group, 0.7% of the left nephrectomy group, and 1.36% of the radical left nephrectomy) experienced iatrogenic injuries to the pancreas. None of the injuries were recognized intraoperatively. All patients were treated with drains in an attempt to control the pancreatic leak and one patient required additional surgical interventions. Average length of stay was 65 days (range 15-190 days). Mean follow-up was 23.3 months (range 7.7-115 months). CONCLUSIONS: Pancreatic injuries during nephrectomy are rare and carry a significant risk for postoperative morbidity.


Asunto(s)
Carcinoma de Células Renales/cirugía , Enfermedad Iatrogénica , Neoplasias Renales/cirugía , Nefrectomía/efectos adversos , Páncreas/lesiones , Enfermedades Pancreáticas/etiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/patología , Estudios de Cohortes , Tratamiento Conservador/métodos , Femenino , Estudios de Seguimiento , Humanos , Israel , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Nefrectomía/métodos , Enfermedades Pancreáticas/mortalidad , Enfermedades Pancreáticas/terapia , Reoperación/métodos , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Tasa de Supervivencia , Centros de Atención Terciaria
9.
Int J Surg ; 76: 121-127, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32169573

RESUMEN

BACKGROUND: Short and long-term outcomes after repeat anti-reflux surgery (RARS) are still debated and generally not considered as satisfying as after primary anti-reflux surgery (PARS). The aim of this study was to evaluate functional outcomes after RARS and risk factors associated to intra-operative and post-operative complications. METHODS: This is a multicenter retrospective survey from four European laparoscopic centers. Patients who underwent elective RARS from January 2005 to October 2017 for dysphagia or for persistent reflux disease refractory to medical treatment were analyzed. Data on demographic characteristics, including type and timing of previous operations as well as intra-operative details (surgical technique, type of RARS, conversion to open surgery, prosthetic material placement) were collected. Patients who underwent operations in the emergency setting, interventions mixed with bariatric procedures and PARS performed in other surgical departments were not included in this study. Primary endpoint of this study was to evaluate risk factors associated with intraoperative and postoperative complications. Secondary endpoint was to evaluate clinical outcomes and to identify any possible correlation with clinical and surgical parameters. RESULTS: Among 1662 patients who underwent PARS, failure occurred in 174 (10.5%) patients. Repeat surgery was performed in 117 (7%) patients, after a mean time of 80 months (range 4-315). RARS was carried out laparoscopically in 88% of cases. Prosthetic mesh to reinforce hiatoplasty was used in 22.2% of patients. Intra-operative upper gastro-intestinal tract's injuries occurred in 6 (5.1%) patients. Perioperative mortality was nil and 13 (11.1%) patients experienced postoperative complications. Mean length of hospital stay was 9.6 ± 6.4 days. Based on a multivariable analysis, age >70 years (OR 1.074, C.I.95% 1.018-1.133, p = 0.008) and body mass index (BMI) < 23 (OR 0.172, C.I.95% 0.052-0.568, p = 0.004) were independently associated to postoperative complications. After a mean follow-up time of 36 months (range 6-107), 24 (20.5%) patients presented recurrent symptoms. Based on a multivariable analysis, early onset of dysphagia (OR 3.539, C.I.95% 1.254-9.990, p = 0.017), open approach (OR 4.505, C.I.95% 1.314-15.442, p = 0.016) and the use of prosthetic material (OR 2.790, C.I.95% 0.930-8.776, p = 0.047) were significantly associated to good clinical outcomes. CONCLUSIONS: Repeat anti-reflux surgery is a safe and feasible procedure in high-volume centers, with acceptable perioperative outcomes. Long-term results are favorable with a success rate of almost 80%. Advanced age (>70 years) and low BMI (<23 kg/m2) were factor predicting perioperative complications. The use of prosthesis for hiatoplasty was associated to better functional outcomes.


Asunto(s)
Fundoplicación , Reflujo Gastroesofágico , Laparoscopía , Adulto , Anciano , Estudios de Cohortes , Conversión a Cirugía Abierta , Trastornos de Deglución/etiología , Femenino , Fundoplicación/métodos , Reflujo Gastroesofágico/cirugía , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Reoperación/métodos , Estudios Retrospectivos , Segunda Cirugía , Encuestas y Cuestionarios , Pérdida de Peso
11.
Isr Med Assoc J ; 22(2): 89-93, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043325

RESUMEN

BACKGROUND: There are several ways to remove silicone oil (SO) from the vitreous cavity. OBJECTIVES: To describe a simple, safe and inexpensive method of 2-port SO removal. METHODS: Medical charts of 33 patients who underwent SO removal combined with cataract extraction were retrospectively reviewed, from a cohort of 119 patients who had silicone oil removal. The primary outcome was the rate of re-detachment, secondary outcomes included visual acuity (VA) and intraoperative and postoperative complications. RESULTS: Mean follow-up time was 27.6 months (0.25-147 ± 33.1), and mean tamponade duration prior to SO removal was 16.77 months (4-51.5 ± 14.6). The re-detachment rate was 3% (one patient). Postoperatively, seven patients (20%) had epiretinal membrane (ERM), eight patients had posterior capsule opacification (24%), and proliferative vitreoretinopathy (PVR) was diagnosed in two patients (6%). Compared to the mean VA (logarithm of the minimum angle of resolution [LogMAR]) at the preoperative examination, the mean VA (LogMAR) improved significantly at the last visit when including all ranges of VA (n=32, LogMAR 1.52 vs. 1.05 P = 0.0002 [Student's t-test] and P = 0.001 [Wilcoxon test]). CONCLUSIONS: The technique described is fast and simple, keeping the posterior capsule intact in pseudophakic patients, which is advantageous in the event of future re-detachment necessitating SO reinjection. Rates of re-detachment and postoperative ERM and PVR were low. Furthermore, our method does not require the use of a surgical microscope with posterior segment viewing systems, or opening a full disposable vitrectomy set, thus drastically reducing the procedure's cost.


Asunto(s)
Endotaponamiento/métodos , Complicaciones Posoperatorias , Desprendimiento de Retina , Aceites de Silicona/uso terapéutico , Succión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación/métodos , Reoperación/estadística & datos numéricos , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/fisiopatología , Desprendimiento de Retina/cirugía , Estudios Retrospectivos , Succión/efectos adversos , Succión/métodos , Resultado del Tratamiento , Agudeza Visual , Cirugía Vitreorretiniana/métodos
12.
Anaesthesia ; 75(4): 479-486, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32037522

RESUMEN

Cell salvage is an important component of blood management in patients undergoing revision hip arthroplasty surgery. However concerns regarding efficacy and patient selection remain. The aims of this study were to describe intra-operative blood loss, cell salvage re-infusion volumes and red blood cell transfusion rates for revision hip procedures and to identify factors associated with the ability to salvage sufficient blood intra-operatively to permit processing and re-infusion. Data were collected from a prospective cohort of 664 consecutive patients undergoing revision hip surgery at a single tertiary centre from 31 March 2015 to 1 April 2018. Indications for revision surgery were aseptic (n = 393 (59%)) fracture (n = 160 (24%)) and infection (n = 111 (17%)). Salvaged blood was processed and re-infused when blood loss exceeded 500 ml. Mean (SD) intra-operative blood loss was 1038 (778) ml across all procedures. Salvaged blood was re-infused in 505 of 664 (76%) patients. Mean (SD) re-infusion volume was 253 (169) ml. In total, 246 of 664 (37%) patients received an allogeneic red blood cell transfusion within 72 h of surgery. Patients undergoing femoral component revision only (OR (95%CI) 0.41 (0.23-0.73)) or acetabular component revision only (0.53 (0.32-0.87)) were less likely to generate sufficient blood salvage volume for re-infusion compared with revision of both components. Compared with aseptic indications, patients undergoing revision surgery for infection (1.87 (1.04-3.36)) or fracture (4.43 (2.30-8.55)) were more likely to generate sufficient blood salvage volume for re-infusion. Our data suggest that cell salvage is efficacious in this population. Cases where the indication is infection or fracture and where both femoral and acetabular components are to be revised should be prioritised.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Transfusión de Sangre Autóloga/métodos , Cuidados Intraoperatorios/métodos , Recuperación de Sangre Operatoria/métodos , Reoperación/métodos , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
13.
Acta Orthop ; 91(2): 165-170, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31928096

RESUMEN

Background and purpose - The increasing use of hip arthroplasties in young patients will inevitably lead to more revision procedures at younger ages, especially as the outcome of their primary procedures is inferior compared with older patients. However, data on the outcome of revision hip arthroplasty in young patients are limited. We determined the failure rates of revised hip prostheses performed in patients under 55 years using Dutch Arthroplasty Register (LROI) data.Patients and methods - All 1,037 revised hip arthroplasty procedures in patients under 55 years at the moment of revision registered in the LROI during the years 2007-2018 were included. Kaplan-Meier survival analyses were used to calculate failure rates of revised hip arthroplasties with endpoint re-revision for any reason. Competing risk analyses were used to determine the probability of re-revision for the endpoints infection, dislocation, acetabular and femoral loosening, while other reasons for revisions and death were considered as competing risks.Results - Mean follow-up of revision procedures was 3.9 years (0.1-12). 214 re-revisions were registered. The most common reason for the index revision was dislocation (20%); the most common reason for re-revision was infection (35%). The 5-year failure rate of revised hip prostheses was 22% (95% CI 19-25), and the 10-year failure rate was 28% (CI 24-33). The 10-year cumulative failure rates of index revisions with endpoint re-revision for infection was 7.8% (CI 6.1-9.7), acetabular loosening 7.0% (CI 4.1-11), dislocation 3.8% (CI 2.6-5.2), and femoral loosening 2.7% (CI 1.6-4.1). The 10-year implant failure rate of index revisions for infection was 45% (CI 37-55) with endpoint re-revision for any reason.Interpretation - Failure rate of revised hip prostheses in patients under 55 years is worrisome, especially regarding index revisions due to infection. This information facilitates realistic expectations for these young patients at the time of primary THA.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Falla de Prótesis/etiología , Reoperación/métodos , Adolescente , Adulto , Factores de Edad , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Estudios de Seguimiento , Luxación de la Cadera/epidemiología , Luxación de la Cadera/etiología , Luxación de la Cadera/cirugía , Prótesis de Cadera/efectos adversos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Fracturas Periprotésicas/epidemiología , Fracturas Periprotésicas/etiología , Fracturas Periprotésicas/cirugía , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/cirugía , Sistema de Registros , Reoperación/efectos adversos , Reoperación/estadística & datos numéricos , Resultado del Tratamiento , Adulto Joven
14.
J Cardiovasc Surg (Torino) ; 61(2): 256-263, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31985187

RESUMEN

We report on the case of spontaneous rupture of an On-X-pure pyrolytic carbon mechanical valve prosthesis implanted seven years earlier, in a mitral position, at our hospital. The patient was admitted with valvular dysfunction and acute pulmonary edema requiring emergency surgery (prosthesis replacement); the absence of a leaflet was confirmed intraoperatively. The patient presented severe respiratory failure, which prolonged the postoperative period. A CT scan showed that the migrated leaflet was located in the aortic bifurcation with no apparent arterial lesion. Four months later, once the patient had recovered, laparotomy and aortotomy were performed in order to retrieve the leaflet, which was found to have become included (neoendothelized) in the aortic wall without compromising the latter's integrity or obstructing the blood flow. A subsequent CT scan confirmed the persistence of the leaflet in its initial position. The literature review highlights two singular facts: 1) this is the second published case of the escape of a leaflet from an On-X prosthesis (the first patient died); 2) this is the first case in which a laparotomy was performed to retrieve the leaflet but finally a decision was made to leave it in situ. Seven months later, the patient remained asymptomatic.


Asunto(s)
Bioprótesis/efectos adversos , Migración de Cuerpo Extraño/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Falla de Prótesis , Enfermedad Aguda , Procedimientos Quirúrgicos Cardíacos/métodos , Servicio de Urgencia en Hospital , Estudios de Seguimiento , Migración de Cuerpo Extraño/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiología , Reoperación/métodos , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
15.
World Neurosurg ; 136: 117-121, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31954887

RESUMEN

OBJECTIVE: We sought to evaluate the feasibility for awake, endoscopic treatment of lumbar pseudarthrosis after a transforaminal lumbar interbody fusion (TLIF). METHODS: A 71-year-old male with severe cardiac disease, determined to be high risk for general anesthesia, presented with mechanical back pain and a L3-4 pseudarthrosis and L3 pedicle screw loosening after a L3-5 TLIF. An awake, transforaminal endoscopic redo diskectomy and TLIF procedure were performed by removing residual disk material adjacent to the previous "PEEK" (polyetheretherketone) interbody spacer and placing allograft, bone morphogenetic protein, and an expandable titanium interbody device adjacent to the PEEK cage. RESULTS: At 1-year follow-up, preoperative visual analog scale for back pain and Oswestry disability index improved from 7 and 38% to 1 and 2%. The 1-year follow-up radiograph showed stable interbody placement and no further screw loosening. CONCLUSIONS: A minimally invasive, awake procedure is presented for the treatment of pseudarthrosis after TLIF.


Asunto(s)
Vértebras Lumbares/cirugía , Neuroendoscopía/métodos , Complicaciones Posoperatorias/cirugía , Seudoartrosis/cirugía , Fusión Vertebral/métodos , Anciano , Trasplante Óseo/métodos , Discectomía/métodos , Falla de Equipo , Humanos , Masculino , Tornillos Pediculares , Complicaciones Posoperatorias/diagnóstico por imagen , Implantación de Prótesis/métodos , Seudoartrosis/diagnóstico por imagen , Reoperación/métodos , Vigilia
16.
World Neurosurg ; 133: e26-e30, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31398523

RESUMEN

OBJECTIVE: This study aims to report the clinical outcome of stand-alone lateral lumbar interbody fusion (LLIF) on recurrent disk herniation and to compare the outcome of stand-alone LLIF to that of conventional transforaminal lumbar interbody fusion (TLIF). METHODS: A retrospective study of 47 patients with recurrent disk herniation was included from January 2008 to October 2016. The inclusion criteria were 1) with recurrent disk herniation that needs revision surgery, 2) with only 1 previous percutaneous endoscopic lumbar diskectomy surgery, 3) underwent 1-level stand-alone LLIF or 1-level TLIF surgery, and 4) with follow-up more than 1 year. Patients were asked to complete the following questionnaires for outcome evaluation: visual analog scales (VAS) for both low back pain and leg pain, the Oswestry Disability Index (ODI), and the 12-item Short-Form Health Survey. RESULTS: Eighteen patients underwent stand-alone LLIF, and 29 patients underwent TLIF surgery. Radiographic analysis revealed a similar baseline and postoperative lumbar lordosis in both the LLIF and TLIF groups. Two weeks after surgery, the ODI and VAS scores showed a significant decrease in both groups. The TLIF group showed significantly larger postoperative VAS back pain after surgery (P = 0.03). For both VAS leg pain and ODI score during follow-up, no significance difference was found between the LLIF and TLIF groups. CONCLUSIONS: Stand-alone LLIF is a safe and effective approach with low morbidity and acceptable complication rates for patients with recurrent disk herniation after a previous percutaneous endoscopic lumbar diskectomy surgery. Compared with the TLIF procedure, LLIF could achieve a similar improvement of patient-reported outcome with a better VAS back pain score.


Asunto(s)
Discectomía Percutánea/métodos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Neuroendoscopía/métodos , Reoperación/métodos , Anciano , Evaluación de la Discapacidad , Femenino , Humanos , Dolor de la Región Lumbar/etiología , Masculino , Persona de Mediana Edad , Manejo del Dolor , Complicaciones Posoperatorias/etiología , Recurrencia , Estudios Retrospectivos , Ciática/etiología , Fusión Vertebral/métodos , Resultado del Tratamiento
17.
J Surg Res ; 246: 1-5, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31541708

RESUMEN

BACKGROUND: Intestinal atresia is a congenital defect resulting in intestinal discontinuity and can be associated with significant morbidity related to intestinal failure. The bowel proximal to the atresia is often significantly dilated and dysfunctional. The treatment approaches of this dilated bowel include resection with primary anastomosis versus tapering enteroplasty with preservation of bowel length. The purpose of this study was to compare these two approaches in regard to bowel function as characterized by the time to full enteral feeding. METHODS: A retrospective review was performed of intestinal atresia repair performed at a tertiary referral pediatric hospital from 2007 to 2017. Length of stay, time to full enteral feeds, and complications were assessed in patients who underwent repair with tapering enteroplasty (n = 8) and compared with those who underwent resection and anastomosis (n = 39). RESULTS: The median age at surgery, gender distribution, weeks gestational age (WGA), location of the atresia, and comorbidities were similar between the two groups. Overall, there was no statistically significant difference in length of stay and time to full enteral feeds between groups. Three of eight (38%) patients in the tapered group and five of 39 patients (13%; P = 0.12) in the nontapered group underwent further surgical exploration because of bowel dysmotility. Factors associated with longer length of hospital stay were abdominal reoperation and WGA, and factors associated with longer time to full enteral feeds were WGA, abdominal reoperation, and gastroschisis. CONCLUSIONS: Tapering enteroplasty at initial operation for intestinal atresias preserves bowel length and has statistically equivalent outcomes to resection and anastomosis in regard to the length of stay and time to full enteral feeds.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Nutrición Enteral/estadística & datos numéricos , Atresia Intestinal/cirugía , Intestino Delgado/anomalías , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Dilatación Patológica/etiología , Dilatación Patológica/cirugía , Femenino , Motilidad Gastrointestinal , Humanos , Lactante , Recién Nacido , Atresia Intestinal/complicaciones , Intestino Delgado/cirugía , Tiempo de Internación/estadística & datos numéricos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
18.
Orthop Clin North Am ; 51(1): 27-36, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31739877

RESUMEN

Distal femoral replacement (DFR) is a reasonable treatment option when used for select indications. In the setting of comminuted intra-articular distal femoral fractures, distal femoral arthroplasty should be considered in low-demand patients with poor bone quality. This article summarizes the existing literature plus the authors' personal experience with DFR use for distal femoral fractures of the native knee.


Asunto(s)
Fracturas del Fémur/cirugía , Fémur/cirugía , Fracturas Conminutas/cirugía , Articulación de la Rodilla/cirugía , Anciano , Humanos , Fracturas Intraarticulares/cirugía , Persona de Mediana Edad , Cuidados Posoperatorios , Implantación de Prótesis/métodos , Reoperación/métodos , Reoperación/estadística & datos numéricos , Reimplantación/métodos , Reimplantación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento
19.
World Neurosurg ; 135: 58-62, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31841720

RESUMEN

BACKGROUND: Cylindrical expandable cages are commonly used as interbody grafts after cervical, thoracic, or lumbar corpectomy in patients with osteomyelitis. Unfortunately, there is a high incidence of hardware subsidence due to small-diameter footplates. Newer expandable intervertebral cages with large rectangular endcaps use the anatomic strength of the vertebral epiphyseal ring to prevent subsidence. CASE DESCRIPTION: A 67-year-old man with medically refractory thoracic osteomyelitis and discitis presented to our service for further management of debilitating back pain secondary to a persistent infection and associated progressive spinal kyphotic deformity. He underwent a transpedicular T9-10 corpectomy, placement of an expandable interbody cage, and posterior instrumented spinal fusion from T7 to T12. On postoperative day 2, upright thoracic radiographs demonstrated cage subsidence of >50% into the T8 vertebral body. The patient was returned to the operating room for hardware revision and placement of an expandable intervertebral cage with rectangular endcaps through a minimally invasive lateral retropleural approach to the thoracic spine. The patient tolerated the procedure well, and no evidence of subsidence occurred after the revision after 2 years of follow-up. CONCLUSIONS: Expandable intervertebral cages with rectangular endcaps can be used to prevent and/or correct preexisting cage subsidence in patients in need of anterior column instrumentation, especially in those with bone-weakening pathologies. Prospective studies should be entertained to evaluate subsidence rates in cages with cylindrical versus rectangular endcaps.


Asunto(s)
Falla de Equipo , Fijadores Internos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Terapia Recuperativa/métodos , Vértebras Torácicas/cirugía , Anciano , Humanos , Masculino , Reoperación/métodos , Fusión Vertebral , Vértebras Torácicas/diagnóstico por imagen
20.
Urology ; 137: 178-182, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31866523

RESUMEN

OBJECTIVE: To investigate the incidence and risk factors associated with artificial urinary sphincter (AUS) and male urethral sling placement (MUS), revision, and removal. METHODS: We identified CPT codes of patients undergoing AUS and sling placement, revision, and removal in the American College of Surgeons National Surgery Quality Improvement Program database. Bivariate analysis was used to compare preoperative parameters against adverse events of interest (Length of stay (LOS) >1, readmission, reoperation, other postoperative complications, and death). Variables that were significant or neared significance (P <.1) in the univariate analysis were entered into multivariable logistic regression models. Multivariable models were used to estimate the probability of adverse events. RESULTS: About 2792 patients underwent surgical treatment for stress urinary incontinence in the American College of Surgeons National Surgery Quality Improvement Program database from 2008 to 2016. Increased length of stay was the most common adverse event (12.7%), followed by other postoperative complications (4.9%), readmission (4%), reoperation (2.3%), and death (0.3%). We noted an association between perioperative adverse events and preoperative hypoalbuminemia. Patients with preoperative hypoalbuminemia compared with patients with normal preoperative serum albumin had an increase predicted probability of LOS >1 day (42% vs 10%), readmission (10% vs 4%), reoperation (6% vs 2%), other postoperative complications (18% vs 4%) after adjusting for other factors. CONCLUSION: Surgical treatment for stress urinary incontinence is well tolerated with acceptable levels of perioperative adverse events. Low serum albumin (<3.5 ng/dL) was associated with perioperative adverse events. These data may affect preoperative decision making and direct future quality improve efforts at the highest risk patients to help minimize perioperative morbidity and mortality.


Asunto(s)
Complicaciones Posoperatorias , Implantación de Prótesis , Reoperación , Albúmina Sérica/análisis , Cabestrillo Suburetral/estadística & datos numéricos , Incontinencia Urinaria de Esfuerzo , Esfínter Urinario Artificial/estadística & datos numéricos , Anciano , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/instrumentación , Implantación de Prótesis/métodos , Mejoramiento de la Calidad/organización & administración , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Ajuste de Riesgo/métodos , Factores de Riesgo , Estados Unidos/epidemiología , Incontinencia Urinaria de Esfuerzo/sangre , Incontinencia Urinaria de Esfuerzo/epidemiología , Incontinencia Urinaria de Esfuerzo/cirugía
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