Double outlet right ventricle.

This review article addresses the history, morphology, anatomy, medical management, and different surgical options for patients with double outlet right ventricle.

Standardizing Discharge Furosemide Duration Following Congenital Heart Surgery.

Background: Pediatric cardiothoracic surgery has evolved over the last several decades with shorter bypass times and less need for hypothermic arrest. Diuretics have been commonly used in the post-operative period with no guidelines on duration following cardiopulmonary bypass. As a result, we conducted a single-center quality improvement project to reduce overuse of diuretics in post-operative patients without causing an increase in complications. We devised an early diuretic wean protocol that was implemented upon patient discharge. Methods: All patients who underwent uncomplicated congenital heart surgery after November 2018 were considered for the protocol. We defined an early diuretic wean protocol with a total duration of ten days of single diuretic therapy following hospital discharge. Patients were evaluated in clinic two weeks following discharge, after completion of diuretic therapy, to assess for clinical symptoms and development of effusions. Results: Retrospective pre-protocol data found the average duration a patient was on diuretics was 32 days following hospital discharge from uncomplicated congenital heart surgery. Following implementation of the protocol, there was a decrease in the total duration to 14 days, demonstrating a 56% decrease. With this practice change, there was no notable increase in adverse events. Conclusions: With implementation of the protocol, practice variability was minimized and the average post-operative diuretic duration was decreased without an increase in pleural and/or pericardial effusions or readmissiosn rates. Future directions and ongoing changes include expanding to a multicenter quality improvement collaborative focusing on decreasing the average duration of furosemide to less than five days after hospital discharge.

The collateral impact of COVID19 among surgeonsand residents: Second cross-sectional survey about the Colombian perspective / El impacto colateral del COVID-19 entre cirujanos y residentes: Segunda encuesta transversal sobre la perspectiva colombiana

Introduction. The COVID-19 pandemic has led health services to adapt, surgical training has had to restructure, and personal life has had to thrive hardships. We aimed to describe the evolution of surgeons' and residents' per-ceptions about the impact COVID-19 has had on Colombia's surgical practice.Methods. Descriptive cross-sectional study using a structured electronic survey among general surgery residents, and graduated surgeons who have a clinical practice in Colombia.Results. 355 participants were included, with a median age of 37 years (IQR 30, 51), and 32.1% female. There were 28.7% residents, 43.3% general surgeons, and 27.8% subespecialist in surgery. Overall, 48.7% of respondents were from Bogotá, and 38.8% worked at academic private hospitals. Although almost all participants reported having used telemedicine platforms during the pandemic, 58% of the respondents did not view telemedicine as sufficient for follow-up consults. More than 80% of surgeons surveyed reported that their monthly incomes had been reduced. Discussion. The second survey showed a better-perceived adherence to safety protocols at their institutions than at the beginning of the pandemic. However, the toll on economic and academic domains are substantial among the surgical community. As the pandemic's effects are expected to last longer in our region, telemedicine services acceptance and healthcare providers' job stability need to be improved in Colombia

Introducción. La pandemia ha llevado a los servicios de salud a adaptarse, la formación quirúrgica ha tenido que reestructurarse y la vida personal ha tenido que prosperar en las dificultades. Nuestro objetivo fue describir la evolución de las percepciones de cirujanos y médicos residentes sobre el impacto que ha tenido el COVID-19 en la práctica quirúrgica de Colombia. Métodos. Estudio de corte transversal descriptivo mediante encuesta estructurada distribuida electrónica-mente a médicos residentes de cirugía general, cirujanos generales o sub-especialistas, con práctica clínica en Colombia. Resultados. Se incluyeron 355 participantes, con una mediana de edad de 37 años (RIC 30-51) y el 32,1 % fueron mujeres. El 28,7 % eran médicos residentes, el 43,3 % cirujanos generales y el 27,8 % subespecialistas en cirugía. El 48,7 % de los encuestados vivían en Bogotá y el 38,8 % trabajaba en hospitales académicos privados. Aunque la mayoría ha utilizado plataformas de telemedicina durante la pandemia, el 58 % de los encuestados no consideró que la telemedicina fuera suficiente para las consultas postoperatorias. Más del 80 % de los cirujanos encuestados informaron que sus ingresos mensuales se habían reducido. Discusión. La segunda encuesta mostró una mejor percepción de la adherencia a los protocolos de seguridad en sus instituciones que al comienzo de la pandemia. Sin embargo, el costo en los dominios económicos y académicos es considerable entre la comunidad quirúrgica. Dado que se espera que los efectos de la pandemia duren más en nuestra región, es necesario mejorar la aceptación de los servicios de telemedicina y la estabilidad laboral de los proveedores de atención médica en Colombia

Adult cardiac surgical cost variation around the world: Protocol for a systematic review.

INTRODUCTION: Globally, over one million cardiac operations occur each year, whereas cardiac surgery is expensive and largely inaccessible without insurance or philanthropic support. Substantial cost variation has been reported within cardiac surgery in the United States and among non-cardiac surgical procedures globally, but little is known on the global procedural cost variation for common adult cardiac surgical procedures. OBJECTIVES AND SIGNIFICANCE: This review seeks to assess variation in procedural costs of coronary artery bypass grafting (CABG), mitral valve repair, mitral valve replacement, aortic valve repair, aortic valve replacement, and combined CABG-mitral or CABG-aortic valve procedures between and within countries. Results may give insights in the scope and drivers of cost variation around the world, posing cost reduction lessons. Results may further inform the potential of economies of scale in reducing procedural costs, benefiting patients, hospitals, governments, and insurers. METHODS AND ANALYSIS: A systematic review will be performed using the EconLit, Embase, PubMed/MEDLINE, Web of Science, and WHO Global Index Medicus databases to identify articles published between January 1, 2000 and June 1, 2020. Studies describing procedural costs for CABG, mitral valve repair, mitral valve replacement, aortic valve repair, aortic valve replacement, and combined CABG-mitral or CABG-aortic valve procedures will be identified. Articles describing other types of cardiac surgery, concomitant aortic surgery, only describing costs related to non-surgical care, or with incomplete cost data will be excluded from the analysis. No exclusion will be based solely on article type or language. Identified costs will be converted to 2019 USD to account for local currency unit inflation and exchange fluctuations. ETHICS AND DISSEMINATION: This study protocol has been prospectively registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols. This review requires no institutional review board approval. Results of this study will be summarized and disseminated in a peer-review journal.

Experiencia y curva de aprendizaje de apendicectomía y colecistectomía laparoscópica de los residentes de cirugía general en un hospital latinoamericano / General Surgery Residents Experience and Learning Curve for Laparoscopic Appendectomy and Cholecystectomy in a Latin American Hospital

Introducción: La cirugía laparoscópica ha revolucionado el manejo quirúrgico de los pacientes y ha generado una necesidad de capacitación en el área. El rendimiento en la vida real es lo que permite una determinación global de las competencias en un procedimiento y establece un método de formación. El objetivo de este estudio es describir la evolución en la experiencia quirúrgica de un grupo de residentes de cirugía general. Metodología: Estudio observacional analítico de cohorte retrospectiva en el Hospital Universitario San Ignacio. Incluyó 4191 procedimientos realizados, divididos en 1045 apendicectomías laparoscópicas (AL) y 3146 colecistectomías laparoscópicas (CL), realizadas por un total de 52 residentes entre enero de 2008 y diciembre de 2014. Resultados: Tanto en AL como en CL se observó un aumento en el número de procedimientos anuales. Al comparar los tiempos promedios de AL por año de residencia, se observó una tendencia a la disminución en la mediana a medida que el residente era mayor. Las complicaciones intraoperatorias fueron del 0,77% para AL y del 1,9% para CL. La complicación postoperatoria más frecuente fue infección del sitio operatorio con una mortalidad menor al 0,5%. Conclusión: Los resultados evocan la necesidad de continuar con programas de residencia que proporcionen preparación adecuada en el abordaje laparoscópico, posiblemente con exposición cada vez más temprana a procedimientos mínimamente invasivos.

Introduction: Laparoscopic surgery has revolutionized the surgical management of patients, generating a need for training in the area. The performance in real life is what allows a global determination of the competences in a procedure and establishes a method of training. The objective of this study is to describe the evolution in the surgical experience of a group of residents of general surgery.Methodology: Observational analytical study of a retrospective cohort at the University Hospital San Ignacio. It included 4191 surgical procedures divided in 1045 laparoscopic appendectomies (LA) and 3146 laparoscopic cholecystectomies (LC) performed by a total of 52 residents between January 2008 and December 2014. Results: Both LA and LC showed an increase in the number of annual procedures. When comparing the average times of AL per year of residence, a tendency to decrease in the median was observed, as the resident was older. The intraoperative complications were 0.77% for LA and 1.9% for LC; being the most frequent postoperative complication ISO with mortality <0.5%. Conclusion: The results evoke the need to continue with residency programs that provide adequate preparation in the laparoscopic approach, possibly with increasingly early exposure to minimally invasive procedures.