Early Complications in Patients Undergoing Elective Open Surgery for Infrarenal Aortic Aneurysms.

OBJECTIVE: To assess the type and frequency of early postoperative complications in patients after open surgical infrarenal aneurysms repair and determination of their risk factors. STUDY DESIGN: An observational study Place and Duration of Study: The 4th Military Teaching Hospital in Wroclaw, Poland, from January 2012 to December 2016. METHODOLOGY: Analyses of medical records of 205 patients treated for infrarenal aneurysm with open surgery. Patients with clinical and radiological features of aneurysm rupture were excluded. Complications and early deaths (<30 days) were recorded. RESULTS: Men represented 170 (83%) of patients, the average age was 67.9 ± 6.68 years. Aneurysm diameter <60 mm occurred in 107 (52.2%) of patients, 60-80 mm in 76 (37.1%), and >80 mm in 22 (10.7%). Aortic prostheses (tube grafts) were implanted in 132 (64.4%) of patients and aorto-bifemoral (bifurcated) grafts in 73 (35.6%). The most common postoperative complications were: reoperation necessity (n=23; 11.2%), respiratory failure (n=21; 10.2%), respiratory tract infection (n=14; 6.8%), circulatory failure (n=14; 6.8%), lower limb ischemia (n=13; 6.3%), kidney failure (n=12; 5.9%), death (n=9; 4.4%), and surgical wound infection (n=9; 4.4%). Statistical analysis indicated intraoperative blood loss, duration of surgery, a larger aneurysm diameter, and diabetes as risk factors for early complications. CONCLUSION: Complications were the same as reported from other centres. There is a need to shorten surgery duration and minimise blood loss, as these modifiable factors were the predictors of early complications.

Oncologists and Breaking Bad News-From the Informed Patients' Point of View. The Evaluation of the SPIKES Protocol Implementation.

The way that bad news is disclosed to a cancer patient has a crucial impact on physician-patient cooperation and trust. Consensus-based guidelines provide widely accepted tools for disclosing unfavorable information. In oncology, the most popular one is called the SPIKES protocol. A 17-question survey was administered to a group of 226 patients with cancer (mean age 59.6 years) in order to determine a level of SPIKES implementation during first cancer disclosure. In our assessment, the patients felt that the highest compliance with the SPIKES protocol was with Setting up (70.6%), Knowledge (72.8%), and Emotions (75.3%). The lowest was with the Perception (27.7%), Invitation (30.4%), and Strategy & Summary (56.9%) parts. There could be improvement with each aspect of the protocol, but especially in Perception, Invitation, and Strategy & Summary. The latter is really important and must be done better. Older patients felt the doctors' language was more comprehensible (r = 0.17; p = 0.011). Patients' satisfaction of their knowledge about the disease and follow-up, regarded as an endpoint, was insufficient. Privacy was important in improving results (p < 0.01). In practice, the SPIKES protocol is implemented in a satisfactory standard, but it can be improved in each area, especially in Perception, Invitation, and Summary. It is suggested that more training should be done in undergraduate and graduate medical education and the effectiveness of the disclosure continue to be evaluated and improved.