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1.
Medicine (Baltimore) ; 99(24): e20691, 2020 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-32541520

RESUMEN

To compare the safety of implantable Collamer lens (ICL) implantation with and without ophthalmic viscosurgical device (OVD).A total of 148 eyes underwent a conventional ICL implantation with OVD (OVD group), and 112 eyes underwent a modified ICL implantation without OVD (OVD-free group). The balanced salt solution was used to load ICL and maintain the anterior chamber in the OVD-free group. The surgical time, postoperative uncorrected distance visual acuity, intraocular pressure, endothelial cell density (ECD), and percentage of hexagonal cells were compared between the OVD and the OVD-free groups.No significant differences were detected in uncorrected distance visual acuity, intraocular pressure, ECD, and percentage of hexagonal cells at any time post-surgery between the 2 groups (P > .05). The mean ECD loss was 1.9% in the OVD-free group and 2.3% in the OVD group at 2 years post-surgery (P = .680). The surgical time was much shorter in the OVD-free group than that in the OVD group (P ≤ .001). None of the following occurred at any time during the 2-year follow-up period in both groups: cataract formation, macular degeneration, or any other vision-threatening complications.OVD-free ICL implantation presented satisfactory results for safety. Compared to OVD, the OVD-free technique had the advantages of decreased surgical time, increased efficiency, and reduced cost.


Asunto(s)
Implantación de Lentes Intraoculares/instrumentación , Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares , Adulto , Estudios de Cohortes , Femenino , Humanos , Lentes Intraoculares/efectos adversos , Masculino , Tempo Operativo , Estudios Retrospectivos , Adulto Joven
2.
Medicine (Baltimore) ; 99(25): e20538, 2020 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-32569174

RESUMEN

OBJECTIVE: We undertook a meta-analysis to compare the efficacy and safety of single versus double door posterior cervical laminoplasty for cervical spondylotic myelopathy. METHODS: PubMed, Embase, and Cochrane Central Register of controlled trials were searched for randomized controlled trials investigating single and double door posterior cervical laminoplasty for cervical spondylotic myelopathy. The Mantel-Haenszel method with the fixed-effects or random-effects model was used to calculate relative risks and 95% confidence intervals (CIs). RESULTS: Seven studies with 224 patients met the eligibility criteria and were included. There was a significant difference in Japanese Orthopedic Association score (MD = 0.79, 95%CI [0.09, 1.49], P = .03; P for heterogeneity = .09, I = 45%), and adverse events (OR = 0.32, 95%CI [0.11, 0.95], P = .04; P for heterogeneity = 1.00, I = 0%) between the double door posterior cervical laminoplasty group and the single door posterior cervical laminoplasty group. There was no significance in operative time (MD = 0.56, 95%CI [-11.86, 12.98], P = .93; P for heterogeneity = 0.001, I = 73%) and length of hospital stay (OR = -0.75, 95%CI [-1.78, 0.27], P = .15; P for heterogeneity = 1.00, I = 0%) between the 2 groups. CONCLUSION: Double door posterior cervical laminoplasty is more effective and safer than single door laminoplasty in the treatment of cervical spondylotic myelopathy.


Asunto(s)
Vértebras Cervicales/cirugía , Laminoplastia/métodos , Espondilosis/cirugía , Adulto , Anciano , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 99(24): e20239, 2020 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-32541450

RESUMEN

To evaluate the timing, feasibility, and necessity of early laparoscopic cholecystectomy (LC) in the management of patients with acute calculous cholecystitis complicated with hepatic dysfunction.The clinical data of 60 patients with acute calculous cholecystitis complicated with hepatic dysfunction treated from January 2016 to January 2018 were analyzed retrospectively. A total of 32 patients underwent LC within 72 hours of the cholecystitis attack, 28 patients after 72 hours. The results were compared with those from 28 patients with delayed LC.All the patients were operated by experienced surgeons, and no LC transfer to open operation. No significant differences were detected in the operation time, postoperative complications, intraoperative blood loss, white TBIL, ALT, GGT before and after the operation between the 2 groups (P > .05). Patients who underwent early LC had a short hospital stay and fewer hospital costs (P < .05). All the patients were cured.It is safe, feasible, and necessary to perform LC within 72 hours in patients with acute calculous cholecystitis complicated with hepatic dysfunction. Such patients show a high positive correlation between the inflammation of acute calculous cholecystitis and the damage of hepatic function.


Asunto(s)
Colecistitis Aguda/cirugía , Cálculos Biliares/complicaciones , Hepatopatías/etiología , Hepatopatías/cirugía , Pérdida de Sangre Quirúrgica , Estudios de Casos y Controles , Colecistectomía Laparoscópica/métodos , Estudios de Factibilidad , Femenino , Cálculos Biliares/patología , Humanos , Tiempo de Internación , Hepatopatías/fisiopatología , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Prevención Secundaria/estadística & datos numéricos , Factores de Tiempo , Tiempo de Tratamiento/estadística & datos numéricos , Resultado del Tratamiento
4.
Rev Col Bras Cir ; 47: e20202574, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32578696

RESUMEN

The COVID-19 Pandemic has resulted in a high number of hospital admissions and some of those patients need ventilatory support in intensive care units. The viral pneumonia secondary to Sars-cov-2 infection may lead to acute respiratory distress syndrome (ARDS) and longer mechanical ventilation needs, resulting in a higher demand for tracheostomies. Due to the high aerosolization potential of such procedure, and the associated risks of staff and envoirenment contamination, it is necesseray to develop a specific standardization of the of the whole process involving tracheostomies. This manuscript aims to demonstrate the main steps of the standardization created by a tracheostomy team in a tertiary hospital dedicated to providing care for patients with COVID-19.


Asunto(s)
Infecciones por Coronavirus/cirugía , Procedimientos Quirúrgicos Electivos/normas , Neumonía Viral/cirugía , Centros de Atención Terciaria/normas , Traqueostomía/normas , Aerosoles/efectos adversos , Betacoronavirus , Brasil , Infecciones por Coronavirus/prevención & control , Humanos , Quirófanos/normas , Tempo Operativo , Pandemias/prevención & control , Equipo de Protección Personal/normas , Neumonía Viral/prevención & control
5.
Medicine (Baltimore) ; 99(22): e20414, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32481436

RESUMEN

Endoscopic treatment of duodenal papillary tumors is well described. This study aims to provide new evidence for the treatment of benign papillary tumors through comparisons between endoscopic snare papillectomy (ESP) and endoscopic mucosal resection (EMR).Between May 2010 and December 2017, 72 patients were enrolled. Diagnosis and treatment procedures were ESP and EMR. Endoscopic follow-up evaluation was done periodically as a surveillance measurement for recurrence.Seventy-two patients with ampullary tumors were enrolled, of which 66 had adenomas including 9 high-grade intraepithelial neoplasias and 2 carcinomas in adenoma. Complete resections with tumor-free lateral and basal margins were achieved in all patients. Postoperative complications were bleeding (9.5% in EMR vs 10% in ESP) and pancreatitis (2.4% in EMR and 3.3% in ESP), with no occurrence of perforation, cholangitis or papillary stenosis. Adenoma recurrence was found in 7 patients (14.3% in EMR vs 3.3% in ESP) at 1 year.The ESP procedure is safe and effective for benign ampullary adenoma, high-grade intraepithelial neoplasias, and noninvasive cancer without intraductal tumor growth, which has a shorter procedural duration, as well as lower complication, recurrence rates and hospitalization costs.


Asunto(s)
Neoplasias Duodenales/cirugía , Endoscopía Gastrointestinal , Adenoma/diagnóstico por imagen , Adenoma/patología , Adenoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/diagnóstico por imagen , Carcinoma/patología , Carcinoma/cirugía , Neoplasias Duodenales/diagnóstico por imagen , Neoplasias Duodenales/patología , Endoscopía Gastrointestinal/economía , Endoscopía Gastrointestinal/métodos , Femenino , Estudios de Seguimiento , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Tempo Operativo , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
6.
Medicine (Baltimore) ; 99(21): e20325, 2020 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-32481317

RESUMEN

Gastric cancer (GC) continues to be 1 of the malignant tumors with high morbidity and mortality worldwide. Although the improvements in targeted inhibitor therapy have promoted survival, the first choice for GC patients is still surgery. However, prolonged surgery may tire surgeons and affect surgical outcomes.To detect whether different time-of-day radical gastrectomy influenced short-term and long-term surgical outcomes.This study included 117 patients between 2008 and 2012 who underwent a radical gastrectomy. These patients were grouped into the morning (before 13:00) and afternoon (after 13:00) groups or divided into 2 groups according to the median operation start time (before or after 11:23). Then, the relevant influence of the surgical start time was analyzed.The morning group (before 13:00) and the front median group (before 11:23) showed longer operative time (P = .008 and P = .016, respectively), lower estimated blood loss (P < .001 and P = .158, respectively), and longer time before resuming oral intake (P < .001 and P < .173, respectively) than the afternoon group (after 13:00) or latter median group (after 11:23). Starting the operation in the morning had no effect on the rate of postoperative complications. The operation start time had no significant influence on the overall survival of patients who underwent a radical gastrectomy. However, in subgroup analysis, patients who underwent a distal gastrectomy faced poor prognosis when their surgery started after 13:00 (P = .030).The results suggest that the operation start time might be an indicator of total operative time, estimated blood loss, and the time to resuming oral intake. The operation start time may also influence the prognosis of radical gastrectomy in patients with GC.


Asunto(s)
Gastrectomía/métodos , Complicaciones Posoperatorias/epidemiología , Neoplasias Gástricas/cirugía , Anciano , China/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Tiempo de Internación/tendencias , Masculino , Tempo Operativo , Pronóstico , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
7.
Rev Lat Am Enfermagem ; 28: e3261, 2020.
Artículo en Portugués, Español, Inglés | MEDLINE | ID: mdl-32401901

RESUMEN

OBJECTIVE: to validate the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning in the stratification of risk for injury development in perioperative patients at a rehabilitation hospital. METHOD: analytical, longitudinal and quantitative study. An instrument and the scale were used in the three perioperative phases in 106 patients. The data were analyzed using descriptive and inferential statistics. RESULTS: most patients showed high risk for perioperative injuries, both in the scale score with estimated time and in the real-time score, with a mean of 19.97 (±3.02) and 19.96 (±3.12), respectively. Most participants did not show skin lesions (87.8%) or pain (92.5%). Inferential analysis enabled us to assert that the scale scores are associated with the appearance of injuries resulting from positioning, therefore, it can adequately predict that low-risk patients are unlikely to have injuries and those at high risk are more likely to develop injuries. CONCLUSION: the scale validation is shown by the association of scores with the appearance of injuries, therefore, it is a valid and useful tool, and it can guide the clinical practice of perioperative nurses in rehabilitation hospitals in order to reduce risk for injuries due to surgical positioning.


Asunto(s)
Hospitales de Rehabilitación/normas , Complicaciones Intraoperatorias/prevención & control , Posicionamiento del Paciente/métodos , Medición de Riesgo/normas , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Tempo Operativo , Posicionamiento del Paciente/efectos adversos , Enfermería Perioperatoria/normas , Factores de Riesgo , Heridas y Traumatismos/etiología
8.
Arthroscopy ; 36(5): 1299-1300, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32370892

RESUMEN

The learning curve for hip arthroscopy is steep. This progress represented a combination of both increased technical skill and, importantly, development of more refined surgical indications. In the end, safety and efficiency are aspects of a well performed operation, and the ultimate aspect is long-term patient outcome.


Asunto(s)
Artroscopía , Cirujanos , Estudios de Cohortes , Humanos , Curva de Aprendizaje , Tempo Operativo
9.
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
10.
Medicine (Baltimore) ; 99(19): e20138, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384495

RESUMEN

BACKGROUND: More surgeons have known the importance of parathyroid grand and recurrent laryngeal nerve protection in the surgery, but there is still plenty of scope to improve the surgical techniques. This study aims at investigating whether the improved method of finding recurrent laryngeal nerve (RLN) can protect parathyroid grand and RLN. METHODS: One hundred fifty-eight patients were enrolled and divided randomly into the test and control group according to different methods of finding RLN in the surgery. In the experimental group the author could quickly find the laryngeal recurrent nerve in the lower part of the neck and separate along the surface of the recurrent laryngeal nerve to the point where the recurrent laryngeal nerve gets into the larynx close to the thyroid gland named lateral approach, while in the control group the author severed the middle and lower thyroid vein and raised the lower thyroid pole to look for the RLN near the trachea by the blunt separation. RESULTS: The author identified 152 and 159 parathyroid glands in the test and control group, respectively and there were a lower ratio of auto-transplantation and less operative time in the test group compared with that in the control group. The author also found that the parathyroid hormone level (1 day and 2 months) in the test group was higher than that in the control group. There were no differences in metastatic LN and recurrent laryngeal nerve palsy in the 2 groups. CONCLUSION: The improved method of finding RLN is a simple, efficient and safe way, and easy to implement.


Asunto(s)
Nervio Laríngeo Recurrente/anatomía & histología , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Adulto , China , Femenino , Humanos , Hipoparatiroidismo/tratamiento farmacológico , Hipoparatiroidismo/etiología , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Tempo Operativo , Glándulas Paratiroides/anatomía & histología , Complicaciones Posoperatorias/epidemiología , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/patología
11.
Medicine (Baltimore) ; 99(19): e20143, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384498

RESUMEN

STUDY DESIGN: The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. OBJECTIVE: The present study aimed to conduct a systematic review of overlapping meta-analyses comparing ACDR with fusion for treating CDDD in order to assist decision makers in their selection among conflicting meta-analyses and to provide treatment recommendations based on the best available evidence. SUMMARY OF BACKGROUND DATA: Although several meta-analyses have been performed to compare total disc replacement (TDR) and fusion for treating cervical degenerative disc disease (CDDD), their findings are inconsistent. METHODS: Multiple databases were comprehensively searched for meta-analyses comparing TDR with fusion for treating CDDD. The meta-analyses that comprised only randomized controlled trials (RCTs) were included. Two authors independently assessed the meta-analysis study quality and extracted the data. The Jadad decision algorithm was used to ascertain which meta-analysis studies represented the best evidence. RESULTS: A total of 14 meta-analysis studies were included. All these studies only included RCTs and were determined as Level-II evidence. CONCLUSIONS: Cervical disc arthroplasty was superior compared to anterior discectomy and fusion for the treatment of symptomatic cervical disc disease.


Asunto(s)
Vértebras Cervicales/cirugía , Discectomía/métodos , Degeneración del Disco Intervertebral/cirugía , Fusión Vertebral/métodos , Reeemplazo Total de Disco/métodos , Algoritmos , Discectomía/efectos adversos , Humanos , Metaanálisis como Asunto , Tempo Operativo , Ensayos Clínicos Controlados Aleatorios como Asunto , Rango del Movimiento Articular , Reoperación , Fusión Vertebral/efectos adversos , Reeemplazo Total de Disco/efectos adversos
12.
Medicine (Baltimore) ; 99(20): e20365, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32443389

RESUMEN

Postoperative hyponatremia (POH) is thought to be a fearsome complication of orthopedic surgery. Primary aim of this cohort study was to evaluate the incidence of POH and its clinical relevance in elective surgery, outlining differences between total knee arthroplasty (TKA) and total hip arthroplasty, looking for the presence of any risk factor commonly related to POH.Four hundred two patients that underwent total hip arthroplasty and total knee arthroplasty performed between 2016 and 2017 were retrospectively examined. Serum electrolytes, hemoglobin, hematocrit, glucose, and creatinine were evaluated preoperatively and at day 0-I-II from surgery. Age, sex, body mass index, comorbidities, drugs, surgery data, transfusions, postoperative symptoms, and length of stay (LOS) were determined. All surgeries were performed by the same equipe. Patients had the same perioperative management, excluded those that took thiazides, already at risk of POH.Patients were divided in 2 groups: group A, patients with normal postoperative natremia (294 patients) and group B, patients who developed POH (108, 26.9%); 66.7% of these developed POH within 24 hours postoperatively. In group B mean postoperative natremia was 133.38 (127.78-134.85) mmol/L. Two patients (1.8%) developed moderate hyponatremia, no severe hyponatremia was documented. Type of surgery, operation time, LOS, and presence of postoperative symptoms did not show statistically significant differences within groups. At multivariate logistic analysis chronic use of thiazides was the only variable associated to a decreased risk of developing POH (OR = 0.39; P = .03). Hemoglobin postoperative values (OR = 1.22; P = .03), the need of postoperative transfusion (OR = 2.50; P = .02) and diabetes (OR = 2.70; P = .01) were associated to an increased risk of POH.Although 26.9% of our patients exhibited POH, the onset of this disorder had no implication on postoperative symptoms and on LOS. Diabetes and transfusion are factors most often associated to POH.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Hiponatremia/etiología , Complicaciones Posoperatorias/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Glucemia , Índice de Masa Corporal , Comorbilidad , Creatinina/sangre , Electrólitos/sangre , Femenino , Hematócrito , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales
13.
Eur Rev Med Pharmacol Sci ; 24(9): 5162-5166, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32432781

RESUMEN

OBJECTIVE: Over the ongoing pandemic of coronavirus disease 2019 (COVID-19), the demand for critical care beds among medical services has rapidly exceeded its supply. Elective surgery has comprehensively been drastically limited and allocating intensive care beds to emergency cases or to high risk scheduled elective cases has become an even more difficult task. Here we present our experience which could help to handle undelayable surgical procedures during this emergency. PATIENTS AND METHODS: In 2019, eight patients (4 men, 4 women) with a mean age of 88 years, needing emergency abdominal surgery underwent awake open surgery at our Department of Surgery. All of them were identified as fragile patients at preoperative evaluation by the anesthesiologist. In all cases, locoregional anesthesia (spinal, epidural or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed. RESULTS: None of the patients was intubated. Mean operative time was 80 minutes (minimum 30 minutes, maximum 130 minutes). Intraoperative and postoperative pain were both well controlled. None of them required postoperative intensive care support. No perioperative complications were observed. CONCLUSIONS: Based on our preliminary case series, awake open surgery has resulted feasible and safe. This approach has allowed to perform undelayable major abdominal surgeries on fragile patients when intensive care beds were not available. Surely, it represents a helpful alternative in the COVID-19 era. A streamlining of workflows would fast-track both fragile patients management, as well as healthcare workers' tasks and activity.


Asunto(s)
Anestesia Local/métodos , Infecciones por Coronavirus , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Laparotomía , Pandemias , Neumonía Viral , Vigilia , Anciano de 80 o más Años , Anestesia Epidural/métodos , Anestesia Raquidea/métodos , Betacoronavirus , Femenino , Humanos , Masculino , Tempo Operativo , Dolor Postoperatorio/terapia , Dolor Asociado a Procedimientos Médicos/terapia
15.
Am Surg ; 86(4): 341-345, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-32391758

RESUMEN

Robotic surgery has been widely adopted by many specialties, including hepatobiliary surgery. However, robotic procedures generally require longer operative times and are costlier than their laparoscopic counterparts. The role for robotic cholecystectomy (RC), particularly in patients with advanced liver disease, has not been established. A retrospective analysis of the NSQIP database was performed, focusing on patients with chronic liver disease who underwent cholecystectomy. Patients were categorized based on their model for end-stage liver disease (MELD) score and the type of surgical procedure: open, laparoscopic, or RC. Rates of a variety of postoperative complications including length of stay (LOS) were analyzed. In patients with a MELD score of 21 to 30, open cholecystectomy was associated with a long hospital LOS (3 vs 1 vs 1; P -0.01). RC was equivalent to laparoscopic cholecystectomy in terms of perioperative mortality for higher MELD score patients but was associated with lower conversion rates and overall LOS. This data suggests that RC should be considered in patients with advanced liver disease needing cholecystectomy.


Asunto(s)
Colecistectomía/métodos , Colecistitis/cirugía , Hepatopatías/cirugía , Procedimientos Quirúrgicos Robotizados , Adulto , Colecistectomía Laparoscópica , Enfermedad Crónica , Bases de Datos Factuales , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias , Puntaje de Propensión , Estudios Retrospectivos
16.
Medicine (Baltimore) ; 99(19): e20103, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384484

RESUMEN

Hidden blood loss (HBL) plays an important role in perioperative rehabilitation of patients underwent posterior lumbar fusion surgery. This study was to calculate the volume of HBL and evaluate the risk factors among patients after posterior lumbar fusion surgery.A retrospective analysis was made on the clinical data of 143 patients underwent posterior lumbar fusion surgery from March 2017 to December 2017. Recording preoperative and postoperative hematocrit to calculate HBL according to Gross formula and analyzing its related factors including age, sex, height, weight, body mass index (BMI), surgery levels, surgical time, surgery types, duration of symptoms, disorder type, specific gravity of urine (SGU), plasma albumin (ALB), glomerular filtration rate (GFR), glucose (GLU), drainage volume, hypertension. Risk factors were further analyzed by multivariate linear regression analysis and t test.Eighty-six males and 57 females, mean age 52.7 ±â€Š11.4 years, mean height 162 ±â€Š7.0, mean weight 61.5 ±â€Š9.4, were included in this study. The HBL was 449 ±â€Š191 mL, with a percentage of 44.2% ±â€Š16.6% in the total perioperative blood loss. Multivariate linear regression analysis revealed that patients with higher BMI (P = .026), PLIF procedures (P = .040), and more surgical time (P = .018) had a greater amount of HBL. Whereas age (P = 0.713), sex (P = .276), surgery levels (P = .921), duration of symptoms (P = .801), disorder type (P = .511), SGU (P = .183), ALB (P = .478), GFR (P = .139), GLU (P = .423), hypertension (P = .337) were not statistically significant differences with HBL.HBL is a large proportion of total blood loss in patients after posterior lumbar fusion surgery. BMI >24 kg/m, PLIF procedures, and more surgical time are risk factors of HBL. Whereas age, sex, surgery levels, duration of symptoms, disorder type, SGU, ALB, GFR, GLU, hypertension were not associated with HBL.


Asunto(s)
Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Vértebras Lumbares/cirugía , Hemorragia Posoperatoria/epidemiología , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Adulto , Factores de Edad , Anciano , Índice de Masa Corporal , Pesos y Medidas Corporales , Femenino , Hematócrito , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales
17.
Medicine (Baltimore) ; 99(18): e20153, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358405

RESUMEN

At present, the posterior cervical approach with open reduction and internal fixation (ORIF) remains a commonly effective treatment for unstable Atlas fracture. However, the inserted screws into the C1 lateral mass of some unstable atlas fracture are very difficult, so that the operation is forced to change into C0 to C2 fusion. In order to improve the successful rate of lateral mass screw placement, we introduced a method of fixing lateral mass with a towel clamp in posterior transpedicular fixation, and explore the efficacy and feasibility.Twenty-one consecutive patients with unstable atlas fracture were treated via this method from October 2012 to July 2017. All cases had neck pain and restricted motion of neck movement on admission. Electronic medical records and pre- and postoperative radiographs were reviewed. Screw and rod placement, bone fusion, and spinal cord integrity were assessed via long-term follow-up with anteroposterior and lateral radiographs and computed tomography. Follow-up included clinical assessment of neurological function, assessment of pain using the visual analog scale (VAS), and assessment of the activities of daily living using the neck disability index (NDI).The mean follow-up duration was 22.1 months (range: 12-54 months). No screw loosening or breakage, plate displacement, neurovascular injury, and severe complications occurred during follow-up. The mean operative time was 112.4 ±â€Š14.9 min (range: 82-135 min), and mean blood loss was 386.2 ±â€Š147.9 mL (range: 210-850 mL). One patient experienced continuous neck pain postoperatively, but this gradually disappeared with analgesic administration. At final follow-up, all patients had bone fusion, the VAS scores and NDI were significantly improved compared with preoperatively.Fixing the C1 lateral mass with a towel clamp during posterior transpedicular fixation for unstable atlas fracture appears to be a safe and reliable method, with the advantages of being a simple technique with few complications.


Asunto(s)
Atlas Cervical/lesiones , Atlas Cervical/cirugía , Fijación Interna de Fracturas/métodos , Fracturas de la Columna Vertebral/cirugía , Actividades Cotidianas , Pérdida de Sangre Quirúrgica , Placas Óseas , Tornillos Óseos , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Rango del Movimiento Articular , Estudios Retrospectivos
18.
Bone Joint J ; 102-B(4): 407-413, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228069

RESUMEN

The application of robotics in the operating theatre for knee arthroplasty remains controversial. As with all new technology, the introduction of new systems might be associated with a learning curve. However, guidelines on how to assess the introduction of robotics in the operating theatre are lacking. This systematic review aims to evaluate the current evidence on the learning curve of robot-assisted knee arthroplasty. An extensive literature search of PubMed, Medline, Embase, Web of Science, and Cochrane Library was conducted. Randomized controlled trials, comparative studies, and cohort studies were included. Outcomes assessed included: time required for surgery, stress levels of the surgical team, complications in regard to surgical experience level or time needed for surgery, size prediction of preoperative templating, and alignment according to the number of knee arthroplasties performed. A total of 11 studies met the inclusion criteria. Most were of medium to low quality. The operating time of robot-assisted total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is associated with a learning curve of between six to 20 cases and six to 36 cases respectively. Surgical team stress levels show a learning curve of seven cases in TKA and six cases for UKA. Experience with the robotic systems did not influence implant positioning, preoperative planning, and postoperative complications. Robot-assisted TKA and UKA is associated with a learning curve regarding operating time and surgical team stress levels. Future evaluation of robotics in the operating theatre should include detailed measurement of the various aspects of the total operating time, including total robotic time and time needed for preoperative planning. The prior experience of the surgical team should also be evaluated and reported. Cite this article: Bone Joint J 2020;102-B(4):407-413.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Competencia Clínica , Medicina Basada en la Evidencia/métodos , Humanos , Estrés Laboral , Tempo Operativo , Osteoartritis de la Rodilla/cirugía , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Robotizados/efectos adversos , Resultado del Tratamiento
19.
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
20.
Surgery ; 167(6): 950-956, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32303347

RESUMEN

BACKGROUND: Few reports have addressed postoperative infectious complications caused by multidrug-resistant pathogens. The aim of this study was to review the surgical outcomes of patients undergoing major hepatectomy with extrahepatic bile duct resection and to clarify the incidence of and the risk factors for postoperative infectious complications caused by multidrug-resistant pathogens. METHODS: Medical records of consecutive patients who underwent major hepatectomy with extrahepatic bile duct resection between 2006 and 2017 were retrospectively reviewed. RESULTS: Among 620 study patients, 219 had postoperative infectious complications, including 62 (10.0%) with postoperative infectious complications caused by multidrug-resistant pathogens. The mortality of the 62 patients with postoperative infectious complications caused by multidrug-resistant pathogens was higher (n = 8, 12.9%) than that in the 157 patients with postoperative infectious complications caused by non-multidrug-resistant pathogens(n = 2, 1.3%) (P < .001). With multivariate analysis, the presence of preoperative cholangitis, the extent of liver resection more than 50%, operative time longer than 600 minutes, the amount of blood loss more than 1500 mL, and the presence of postoperative infectious complications caused by multidrug-resistant pathogens were identified as independent risk factors for postoperative death. The presence of multidrug-resistant pathogens in preoperative bile culture, the amount of blood loss greater than 1500 mL, the presence of bile leakage, and pancreatic fistula were identified as independent risk factors for postoperative infectious complications caused by multidrug-resistant pathogens. CONCLUSION: The incidence of postoperative infectious complications caused by multidrug-resistant pathogens in patients undergoing major hepatectomy with extrahepatic bile duct resection is high, approximately 10%. This troublesome complication is closely associated with postoperative death. Thus, preventing postoperative infectious complications caused by multidrug-resistant pathogens is an urgent task to improve surgical outcome after major hepatectomy with extrahepatic bile duct resection.


Asunto(s)
Bacteriemia/microbiología , Conductos Biliares Extrahepáticos/cirugía , Colangitis/microbiología , Resistencia a Múltiples Medicamentos , Hepatectomía , Neumonía/microbiología , Infección de la Herida Quirúrgica/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Profilaxis Antibiótica , Bacteriemia/tratamiento farmacológico , Neoplasias de los Conductos Biliares/cirugía , Pérdida de Sangre Quirúrgica , Colangiocarcinoma/cirugía , Colangitis/tratamiento farmacológico , Femenino , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Neumonía/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/tratamiento farmacológico , Adulto Joven
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