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1.
J Cardiovasc Med (Hagerstown) ; 21(9): 654-659, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32740498

RESUMO

OBJECTIVE: By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Italy, with thousands of patients infected. In Lombardy, the most affected area, the majority of public and private hospitals were dedicated to caring for COVID-19 patients and were organized following the 'Hub-and-Spoke' model for other medical specialties, like cardiac surgery and interventional procedures for congenital cardiac disease (CHD). Here, we report how the congenital cardiac care system was modified in Lombardy and the first results of this organization. METHODS: We describe a modified 'Hub-and-Spoke' model - that involves 59 birthplaces and three specialized Congenital Cardiac Centers -- and how the hub center organized his activity. We also reported the data of the consecutive cases hospitalized during this period. RESULTS: From 9 March to 15 April, we performed: a total of 21 cardiac surgeries, 4 diagnostic catheterizations, 3 CT scans, and 2 CMR. In three cases with prenatal diagnosis, the birth was scheduled. The spoke centers referred to our center six congenital cardiac cases. The postop ExtraCorporeal Membrane Oxygenation support was required in two cases; one case died. None of these patients nor their parents or accompanying person was found to be COVID-19-positive; 2 pediatric intensivists were found to be COVID-19-positive, and needed hospitalization without mechanical ventilation; 13 nurses had positive COVID swabs (4 with symptoms), and were managed and isolated at home. CONCLUSION: Our preliminary data suggest that the model adopted met the immediate needs with a good outcome without increased mortality, nor COVID-19 exposure for the patients who underwent procedures.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Serviço Hospitalar de Cardiologia , Infecções por Coronavirus , Cardiopatias Congênitas , Controle de Infecções , Pandemias , Assistência Perinatal , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/tendências , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/cirurgia , Humanos , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália/epidemiologia , Masculino , Modelos Organizacionais , Inovação Organizacional , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Cuidados Pós-Operatórios/métodos , Gravidez
2.
Med Clin North Am ; 104(5): 895-908, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773053

RESUMO

Geriatric patients are not just older adult patients. Aging brings about unique physiologic, psychological, and sociologic changes within individuals. Recognition of these unique characteristics and measuring for their impact; instituting mitigating strategies; using age-specific anesthetic measures; and performing a systematic, algorithmic care model in the postoperative period overseen by a multidisciplinary team brings about enhanced outcomes and improved quality of care for this expanding group of patients.


Assuntos
Envelhecimento , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Avaliação Geriátrica/métodos , Humanos , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos
3.
Plast Reconstr Surg ; 146(2): 366-370, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740589

RESUMO

Computed tomographic scans are frequently obtained following craniomaxillofacial fracture reconstruction. The additive radiation from such scans is not trivial; cumulative radiation exposure poses stochastic health risks. In this article, the authors postulate that a low-dose computed tomography protocol provides adequate image quality for postoperative evaluation of reconstructed craniomaxillofacial fractures. This study included patients for whom a computed tomographic scan was indicated following craniomaxillofacial fracture repair at a Level I trauma center. Postoperative craniomaxillofacial computed tomography was performed using a low-dose protocol, rather than standard protocols. A craniomaxillofacial surgeon and a radiologist interpreted the images to determine whether they were of sufficient quality. It was decided a priori that any inadequate low-dose computed tomography would require repeated scanning using standard protocols. The primary endpoint was the need for repeated computed tomography. In addition, the clarity of clinically significant anatomical landmarks on the images was graded on a five-point Likert scale. Twenty patients were scanned postoperatively using the low-dose protocol. Mean radiation dose (total dose-length product) from the low-dose protocol was 71 mGy · cm versus 532 mGy · cm for the preoperative computed tomographic scans that were obtained using conventional protocols (p < 0.001). All 20 low-dose computed tomographic scans were determined to provide satisfactory image quality. No patients required repeated computed tomography secondary to poor image quality. Low-dose computed tomography received high image-quality scores. A low-dose computed tomography protocol that delivers approximately 7.5-fold less radiation than the standard protocols was found to be adequate for postoperative evaluation of craniomaxillofacial fractures. Larger prospective studies may be warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Fixação de Fratura , Cuidados Pós-Operatórios/métodos , Doses de Radiação , Fraturas Cranianas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Humanos , Projetos Piloto , Cuidados Pós-Operatórios/efeitos adversos , Fraturas Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/efeitos adversos , Centros de Traumatologia , Resultado do Tratamento
5.
Bone Joint J ; 102-B(8): 1010-1015, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731826

RESUMO

AIMS: Responsiveness and ceiling effects are key properties of an outcome score. No such data have been reported for the original English version of the International Hip Outcome Tool 12 (iHOT-12) at a follow-up of more than four months. The aim of this study was to identify the responsiveness and ceiling effects of the English version iHOT-12 in a series of patients undergoing hip arthroscopy for intra-articular hip pathology at a minimum of one year postoperatively. METHODS: A total of 171 consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement (FAI) under the care of a single surgeon between January 2013 and March 2017 were included. iHOT-12 and EuroQol 5D-5L (EQ-5D-5L) scores were available pre- and postoperatively. Effect size and ceiling effects for the iHOT-12 were calculated with subgroup analysis. RESULTS: A total of 122 patients (71.3%) completed postoperative PROMs scores with median follow-up of 24.3 months (interquartile range (IQR) 17.2 to 33.5). The median total cohort iHOT-12 score improved significantly from 31.0 (IQR 20 to 58) preoperatively to 72.5 (IQR 47 to 90) postoperatively (p < 0.001). The effect size (Cohen's d) was 1.59. In all, 33 patients (27%) scored within ten points (10%) of the maximum score and 38 patients (31.1%) scored within the previously reported minimal clinically important difference (MCID) of the maximum score. Furthermore, nine (47%) male patients aged < 30 years scored within 10% of the maximum score and ten (53%) scored within the previously reported MCID of the maximum score. CONCLUSION: There is a previously unreported ceiling effect of the iHOT-12 at a minimum one-year follow-up which is particularly marked in young, male patients following hip arthroscopy for FAI. This tool may not have the maximum measurement required to capture the true outcome following this procedure. Cite this article: Bone Joint J 2020;102-B(8):1010-1015.


Assuntos
Artroscopia/métodos , Impacto Femoroacetabular/diagnóstico , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Amplitude de Movimento Articular/fisiologia , Adulto , Estudos de Coortes , Feminino , Impacto Femoroacetabular/cirurgia , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Pesos e Medidas
6.
Rev Col Bras Cir ; 47: e20202548, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844909

RESUMO

OBJECTIVES: compare an accelerated physiotherapeutic protocol to a conventional physiotherapeutic protocol in total hip arthroplasty patients. METHODS: a randomized double blinded clinical trial performed from August 2013 to November 2014. Forty-eight patients diagnosed with hip osteoarthritis submitted to a total hip arthroplasty surgery. An accelerated rehabilitation physiotherapy applied three times a day and start gait training on the first day or standard physiotherapy applied once a day and start gait training on the second or third day of hospitalization. The Merle dAubigné and Postel score (mobility, pain and gait), muscle strength force, range of motion, in hospital stay and time to start of gait training, were the outcomes. RESULTS: the mean age was 64.46 years (10.37 years standard deviation). No differences were observed in age in different genders, and the two randomization groups were homogeneous. In hospital stay was lower in the intervention group compared to the control group, 3 (3-4) days [median (interquartile range)] versus 4 (4-5) days. Time to the start of gait training was early in the intervention group compared to the control group, 1 (1-1) days versus 2 (2-2) days. Higher muscle strength values were observed in the postoperative results in the intervention group compared to the control group for internal rotation, external rotation and abduction. CONCLUSIONS: an accelerated physiotherapeutic protocol should be encouraged, because it shows favourable results in gait, muscle strength and length of hospital stay, even upon hospital discharge.


Assuntos
Artroplastia de Quadril/reabilitação , Marcha , Osteoartrite do Quadril/cirurgia , Cuidados Pós-Operatórios/métodos , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Modalidades de Fisioterapia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento
7.
Rev Esp Anestesiol Reanim ; 67(8): 438-445, 2020 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32814634

RESUMO

COVID-19 infection also affects obstetric patients. Regular obstetric care has continued despite the pandemic. Case series of obstetric patients have been published. Neuroaxial techniques appear to be safe and it is important to obtain the highest possible rate of success of the blocks before a cesarean section. For this reason, it is recommended that the blocks be carried out by senior anesthesiologists. The protection and safety of professionals is a key point and in case of general anesthesia, so it is also recommended to call to the most expert anesthesiologist. Seriously ill patients should be recognized quickly and early, in order to provide them with the appropriate treatment as soon as possible. Susceptibility to thrombosis makes prophylactic anticoagulation a priority.


Assuntos
Anestesiologistas , Betacoronavirus , Cesárea/normas , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez , Analgesia Epidural/métodos , Analgesia Epidural/normas , Analgesia Obstétrica/normas , Anestesia Geral , Anestesia Obstétrica/normas , Cesárea/métodos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Pandemias/prevenção & controle , Isolamento de Pacientes/normas , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Gravidez , Índice de Gravidade de Doença
8.
Am Surg ; 86(8): 907-915, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32805123

RESUMO

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has expanded the utilization of telemedicine in clinical practice to minimize potential risks to both patients and providers. We aim to describe the perception of telemedicine by both surgical patients and providers to understand the preferences for future incorporation in future surgical practice. METHODS: An anonymous survey was administered to providers that transitioned clinic visits to telemedicine encounters since the start of the COVID-19 pandemic. In the second part of the study, patients who underwent video telemedicine appointments answered survey questions via telephone. RESULTS: Twenty-six out of 36 (72.7%) providers responded. Over 75% reported that they could effectively communicate with patients over telemedicine. Six (23.1%) reported that they could adequately assess surgical sites. Of 361 patients, 187 consented to the study (consent rate 51.8%). Among patients, the most common result to choose a telemedicine appointment was to avoid the risk of COVID-19 transmission (84, 44.9%), though the minority reported that they would choose telemedicine after the pandemic (64, 34.2%). Those patients who would choose an in-person visit were more likely to have a higher Charlson Comorbidity Score, body mass index, and use friends or family for transportation. In open-ended feedback, patients suggested that telemedicine would be better suited for long-term follow-up rather than the immediate postoperative setting. CONCLUSIONS: Patients and providers reported a high degree of satisfaction using telemedicine during the COVID-19 pandemic but noted concern with limited physical examinations. Telemedicine may be suited for preoperative evaluation and medium-term and long-term postoperative follow-up for surgical patients.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Cuidados Pós-Operatórios/métodos , Telemedicina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , New Jersey , Pandemias , Satisfação do Paciente , Estudos Retrospectivos , Inquéritos e Questionários , Centros de Atenção Terciária , Adulto Jovem
9.
Medicine (Baltimore) ; 99(29): e20799, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702823

RESUMO

Sessile serrated adenomas (SSAs) are precursors of colorectal cancer (CRC). However, there are limited data on detection rates of this premalignant lesion during colonoscopy surveillance in patients with a history of left side colonic resection for cancer. We aimed to identify the incidence and risk factors of SSAs in post-left side colectomy patients.We retrospectively reviewed the medical records of patients who had undergone left side colectomy for colon and rectal cancer between September 2009 and September 2016 and had at least 1 follow-up colonoscopy. Patient baseline characteristics, SSA diagnoses and characteristics, and colonoscopy information were collected.In total, 539 patients were enrolled. At the first follow-up (mean duration 11.5 months), 98 SSAs were identified (22.2%). At the second follow-up (mean duration 25.8 months), 51 SSAs were identified in 212 patients (24.0%). Multivariate analysis showed that alcohol intake (hazard ratio [HR] 1.524; 95% confidence interval [CI] .963-2.411, P = .041), excellent bowel preparation (HR 2.081; 95% CI 1.214-3.567, P = .049), and use of a transparent cap (HR 1.702; 95% CI 1.060-2.735, P = .013) were associated with higher SSA incidence in the first surveillance colonoscopy, while body mass index (BMI) ≥ 25.0 (HR 1.602; 95% CI 1.060-2.836) was associated with a significantly increased risk of SSAs in the second surveillance.Considering the endoscopic appearance of SSAs, adequate bowel preparation and use of transparent caps during postoperative surveillance colonoscopy can increase the diagnosis rate. Modification of alcohol intake and BMI may reduce the incidence of SSAs in left side colon cancer patients.


Assuntos
Adenoma/epidemiologia , Adenoma/patologia , Neoplasias Colorretais/cirurgia , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Índice de Massa Corporal , Catárticos/efeitos adversos , Colectomia/efeitos adversos , Colonoscopia/métodos , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco
10.
Orthopade ; 49(8): 714-723, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32719918

RESUMO

BACKGROUND: The current study situation regarding the duration of systemic antibiotic treatment for spondylodiscitis is inhomogeneous and varies between 4-12 weeks. Due to the many undesirable side effects the aim is to achieve complete healing without recurrence or hematogenous scatter within the shortest possible period of time. The present pilot study investigated whether the additional application of a local antibiotic carrier to the surgically treated intervertebral disc space can contribute to a further reduction of treatment duration. MATERIAL AND METHODS: In the pilot study 20 patients with acute spondylodiscitis and indications for surgical intervention were included. Surgical treatment was carried out by dorsal instrumentation, radical debridement of the site of infection, and cage interposition in the affected disc space. The remaining disc space was filled with homologous cancellous bone and antibiotic-loaded calcium sulfate hydroxyapatite pellets. A classification into a long-term and a short-term antibiotic group was performed. Both groups initially received a 10-day parenteral antibiotic administration. This was followed by oral antibiotics for 2 or 12 weeks, depending on the group. During the 12-month follow-up inflammation parameters, the local infection situation as well as the bony fusion and antibiotic tolerance were regularly checked. RESULTS: The average age of the patients was 66.7 ± 11.2 years. Intraoperative detection of pathogens was successful in 65%. In 60% the antibiotic carrier was loaded with gentamicin, in 40% with vancomycin. At follow-up, all patients except one in the short-term antibiotic group had inflammation parameters within the normal range after 3 months. In the long-term antibiosis group, two patients still showed elevated infection values after 3 months, otherwise the values were within the normal range. After 12 months a complete cure of the infection was achieved in all patients. Antibiotic treatment intolerance occurred in 10% of the short-term antibiotic group and in 50% of the long-term group. CONCLUSION: The results of the present pilot study show that with the additional use of absorbable local antibiotic carriers in the surgical treatment of bacterial spondylodiscitis it is possible to shorten the duration of systemic antibiotic treatment to 3 weeks. This can reduce the side effects and incompatibility of treatment and still achieve similar healing results.


Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Sulfato de Cálcio/uso terapêutico , Discite/tratamento farmacológico , Discite/cirurgia , Idoso , Idoso de 80 Anos ou mais , Discite/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Resultado do Tratamento
11.
Am Surg ; 86(7): 848-855, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32726131

RESUMO

OBJECTIVES: Colorectal care bundles for surgical site infections (CRCB-SSIs) have been shown to reduce SSIs following elective colorectal surgery (CRS). There are limited data evaluating the effect of CRCB-SSI at Academic Disproportionate Share Hospitals (ADSH) with significant rates of urgent and emergent cases. METHODS: A CRCB-SSI was implemented in April 2016. We reviewed medical records of all patients undergoing colon resections between August 2015 and December 2017. Patients were divided into preimplementation and postimplementation groups. The primary endpoint was the SSI rate, and the secondary endpoint included types of SSI (superficial, deep, organ space). Univariable and multivariable analyses were performed. A subset analysis was performed in elective cases. RESULTS: We analyzed a total of 417 patients. Of these, 116 (28%) and 301 (72%) patients were in the preimplementation and postimplementation groups, respectively. The rate of SSI decreased from 30.1% to 15.9% in the postimplementation group (P = .0012); however, it was not statistically significant after adjusting for baseline differences (relative risk [RR] 0.65; 95% CI 0.41-1.02).The elective subset included 219 patients. The rate of SSI in this cohort decreased from 25% to 10.5% in the postimplementation group (P = .0012) and remained significant following multivariable analysis (RR 0.41, 95% CI 0.19- 0.88). There were no differences in the subtypes of SSI. DISCUSSION: While the CRCB-SSI was effective in decreasing the postoperative SSI rate for elective cases, its effect on the overall patient population was limited. CRCB-SSIs are not enough to bring SSI rates to accepted rates in high-risk patients such as those seen at ADSH.


Assuntos
Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/efeitos adversos , Custos Hospitalares , Avaliação de Resultados em Cuidados de Saúde , Pacotes de Assistência ao Paciente/economia , Infecção da Ferida Cirúrgica/epidemiologia , Centros Médicos Acadêmicos , Adulto , Idoso , Análise de Variância , Estudos de Coortes , Neoplasias Colorretais/economia , Cirurgia Colorretal/economia , Cirurgia Colorretal/métodos , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/métodos , Melhoria de Qualidade , Estudos Retrospectivos , Medição de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapia , Estados Unidos
12.
Cir. pediátr ; 33(3): 131-136, jul. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-193555

RESUMO

OBJETIVO: Analizar si la aplicación de la cirugía laparoscópica en el tratamiento de la estenosis pieloureteral (EPU) ha sido beneficiosa para el paciente pediátrico. MATERIAL Y MÉTODO: Hemos revisado de forma retrospectiva las historias clínicas de todos aquellos pacientes intervenidos de EPU desde enero de 1997 hasta diciembre de 2017. Se excluyeron las que tuvieron seguimiento menor a 6 meses, y las cirugías videoasistidas. Se han comparado la cirugía abierta con la cirugía laparoscópica. Se han recogido los siguientes datos: abordaje quirúrgico, necesidad y tipo de derivación urinaria, tiempo quirúrgico, estancia media, complicaciones, tasa de reestenosis. Los parámetros ecográficos y del renograma diurético también han sido recogidos. RESULTADOS: Se han analizado 328 pieloplastias, 142 se realizaron laparoscópicamente. La tasa de éxito global ha sido del 96,6%, existiendo un 11,9% de complicaciones, sin existir diferencias significativas entre la cirugía abierta y la laparoscópica. En el 97,5% de las cirugías, la orina se derivó mediante catéter nefroureteral externo, catéter doble J o catéter tipo Salle, existiendo diferencias entre cirugía abierta y laparoscópica. El tiempo quirúrgico medio fue significativamente superior en la cirugía laparoscópica. La estancia media fue menor en el grupo de cirugía laparoscópica de forma significativa. CONCLUSIÓN: La vía de abordaje no es un factor que influya en el éxito de la cirugía de la EPU, por ello pensamos que la cirugía laparoscópica es la técnica de elección en pacientes pediátricos


OBJECTIVE: To analyze whether the application of laparoscopic surgery in the treatment of pyeloureteral junction obstruction (PUJO) has been beneficial for pediatric patients. MATERIALS AND METHODS: Medical records of all patients undergoing PUJO surgery from January 1997 to December 2017 were retrospectively reviewed. Patients with < 6-month follow-up and patients undergoing video-assisted surgery were excluded. Open surgery was compared with laparoscopic surgery. The following data were collected: surgical approach, need for and type of urinary diversion, operating time, mean hospital stay, complications, and restenosis rate. Ultrasound and diuretic renogram parameters were also retrieved. RESULTS: 328 Anderson-Hynes pyeloplasties were analyzed, 142 of which had been performed laparoscopically. Overall success rate was 96.6%, and complication rate was 11.9%. No significant differences were noted between open and laparoscopic surgery. In 97.5% of surgeries, urine was diverted using an external nephroureteral catheter, a double J stent, or a Salle stent, with significant differences between open and laparoscopic surgery. Mean operating time was significantly longer in laparoscopic surgery. Mean hospital stay was significantly shorter in the laparoscopic surgery group. CONCLUSION: Surgical approach does not play a role in PUJO surgery success. Therefore, in our view, laparoscopic surgery should be the technique of choice in pediatric patients


Assuntos
Humanos , Masculino , Feminino , Lactente , Procedimentos Cirúrgicos Urológicos/métodos , Obstrução Ureteral/cirurgia , Uretra/cirurgia , Laparoscopia , Estreitamento Uretral/cirurgia , Estudos Retrospectivos , Cuidados Pós-Operatórios/métodos , Estatísticas não Paramétricas , Tempo de Internação
13.
Ann Surg ; 272(2): 377-383, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675552

RESUMO

OBJECTIVE: To investigate the safety and effectiveness of early enteral feeding versus traditional enteral feeding after gastrointestinal (GI) anastomosis in children in the pediatric literature. SUMMARY OF BACKGROUND DATA: Prolonged postoperative fasting has been the traditional model of care following pediatric GI surgery. In contrast, early feeding has become well established in the adult population, where meta-analyses have shown early introduction of enteral feeds to be beneficial to hospital stay and patient outcomes. METHODS: Comprehensive literature searches of the English literature search (PubMed, Ovid, Embase databases) from inception to present according to the PRISMA guidelines. Included studies were assessed according to the MINORS criteria. Outcomes for time to first feed and full feeds, and discharge, and risk of major complications were synthesized. RESULTS: Ten studies comprising 451 patients were included in the analysis. All studies aimed at investigating the safety of early feeding in pediatric GI surgery, with or without a fast-track program. Only 4 studies compared the study group to a control group in which patients were fed in a traditional way (traditional feeding).Most studies defined early feeding as feeds commenced ≤24 hours postoperatively (range 2-72 hours). Mean time to first feed was significantly lower in the early feeding group, but not significantly lower for the mean time to full feeds and mean hospital stay. Bowel obstruction and anastomotic breakdown were classed as major complications. There was no significant difference in their occurrence in both groups. CONCLUSIONS: Although the studies identified are few and heterogeneous, they demonstrate that there is no clear advantage of keeping children "nil by mouth" and no clear disadvantage of providing early enteral nutrition following elective gastrointestinal surgery. Larger randomized controlled trials are required to assess the true impact on postoperative complications, health care associated costs, and to investigate patient-reported outcome measures.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Nutrição Enteral/métodos , Melhoria de Qualidade , Criança , Feminino , Seguimentos , Humanos , Masculino , Cuidados Pós-Operatórios/métodos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Reino Unido
14.
Nutr. hosp ; 37(3): 616-621, mayo-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-193871

RESUMO

INTRODUCTION: glutamine (GLN), the most abundant non-essential amino acid in the plasma, tends to be rapidly depleted in cells in situations of metabolic stress. Some studies have demonstrated the benefits of GLN supplementation on mortality, infection, and length of hospital stay. The objective of this review was to analyze whether parenteral supplementation with GLN has any relevant effect in critically ill surgical patients. METHODS: based on a systematic database search, randomized clinical trials (RCTs) published since 1985 were included if they had evaluated the effect of parenteral GLN supplementation in critical surgical patients. The statistical analysis was performed using the RevMan 5.3 software. RESULTS: seven RCTs were eligible for the meta-analysis. Parenteral glutamine supplementation was associated with a non-significant 24 % reduction in mortality (RR = 0.76; 95 % CI: 0.50-1.15). Infections were significantly reduced (RR = 0.60; 95 % CI: 0.45-0.80), and length of hospital stay was 4.09 days shorter (95 % CI: -6.71 to -1.46). CONCLUSION: parenteral GLN usage in critical surgical patients seems to decrease infection and length of hospital stay, but we could not demonstrate a significant reduction in mortality


INTRODUCCIÓN: la glutamina (GLN), el aminoácido no esencial más abundante en el plasma, tiende a agotarse rápidamente en las células en situaciones de estrés metabólico. Algunos estudios han demostrado beneficios de la suplementación con GLN en términos de reducción de la mortalidad, las infecciones y la duración de la hospitalización. El objetivo de esta revisión es analizar si la suplementación parenteral de GLN tiene algún efecto relevante para los pacientes quirúrgicos en estado crítico. MÉTODOS: basado en una búsqueda sistemática de bases de datos, se incluyeron ensayos clínicos aleatorizados (ECA) publicados desde 1985 si estos habían evaluado el efecto de la suplementación parenteral de GLN en pacientes quirúrgicos críticos. El análisis estadístico se realizó utilizando el software RevMan 5.3. RESULTADOS: siete ECA fueron elegibles para el metaanálisis. La suplementación parenteral de glutamina se asoció a una reducción no significativa del 24 % en la mortalidad (RR = 0,76; IC 95 %: 0,50-1,15). Las infecciones se redujeron significativamente (RR = 0,60; IC 95 %: 0,45-0,80) y la duración de la estancia de hospitalización fue 4,09 días menor (IC 95 %: -6,71 a -1,46). CONCLUSIÓN: el uso de GLN parenteral en pacientes quirúrgicos críticos parece disminuir las infecciones y la duración de la estancia hospitalaria, pero no pudimos demostrar una reducción significativa de la mortalidad


Assuntos
Humanos , Glutamina/uso terapêutico , Cuidados Críticos/métodos , Nutrição Parenteral/métodos , Cuidados Pós-Operatórios/métodos , Soluções de Nutrição Parenteral , Tempo de Internação , Estresse Fisiológico/efeitos dos fármacos , Complicações Pós-Operatórias/prevenção & controle
16.
Bone Joint J ; 102-B(6_Supple_A): 66-72, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475279

RESUMO

AIMS: Postoperative range of movement (ROM) is an important measure of successful and satisfying total knee arthroplasty (TKA). Reduced postoperative ROM may be evident in up to 20% of all TKAs and negatively affects satisfaction. To improve ROM, manipulation under anaesthesia (MUA) may be performed. Historically, a limited ROM preoperatively was used as the key harbinger of the postoperative ROM. However, comorbidities may also be useful in predicting postoperative stiffness. The goal was to assess preoperative comorbidities in patients undergoing TKA relative to incidence of postoperative MUA. The hope is to forecast those who may be at increased risk and determine if MUA is an effective form of treatment. METHODS: Prospectively collected data of TKAs performed at our institution's two hospitals from August 2014 to August 2018 were evaluated for incidence of MUA. Comorbid conditions, risk factors, implant component design and fixation method (cemented vs cementless), and discharge disposition were analyzed. Overall, 3,556 TKAs met the inclusion criteria. Of those, 164 underwent MUA. RESULTS: Patients with increased age and body mass index (BMI) had decreased likelihood of MUA. For every one-year increase in age, the likelihood of MUA decreased by 4%. Similarly, for every one-unit increase in BMI the likelihood of MUA decreased by 6%. There were no differences in incidence of MUA between component type/design or fixation method. Current or former smokers were more likely to have no MUA. Surprisingly, patients discharged to home health service or skilled nursing facility were approximately 40% and 70% less likely than those discharged home with outpatient therapy to be in the MUA group. MUA was effective, with a mean increased ROM of 32.81° (SD 19.85°; -15° to 90°). CONCLUSION: Younger, thinner patients had highest incidence of MUA. Effect of discharge disposition on rate of MUA was an important finding and may influence surgeons' decisions. Interestingly, use of cement and component design (constraint) did not impact incidence of MUA. Level of Evidence II: Prospective cohort study. Cite this article: Bone Joint J 2020;102-B(6 Supple A):66-72.


Assuntos
Anestesia , Artroplastia do Joelho , Manipulação Ortopédica , Cuidados Pós-Operatórios/métodos , Amplitude de Movimento Articular , Idoso , Feminino , Humanos , Masculino , Manipulação Ortopédica/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
18.
Rev Col Bras Cir ; 47: e20202356, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32555960

RESUMO

OBJECTIVE: To investigate the use of "ultra-early" postoperative feeding (oral liquid diet offered in the post-anesthetic recovery room) in patients undergoing common general surgical procedures and to assess the volume of intravenous fluids, as well as the rate of complications and the length of hospital stay. METHODS: Prospective, observational study, which assessed the compliance with the "ultra-early" feeding, the reduction of preoperative fasting time, the perioperative venous hydration volume, the length of stay and the operative morbidity. RESULTS: 154 patients with a mean age of 46 ± 15 years were followed. "Ultra-early" feeding was performed in 144 cases (93.5%). Patients who did not receive the "ultra-early" feeding received a significantly greater volume of postoperative intravenous fluids (500mL versus 200mL, p = 0.018). The length of stay was 2.4 ± 2.79 days (conventional feeding) versus 1.45 ± 1.83 days ("ultra-early" feeding), with no statistical difference (p = 0.133). There was no difference in the percentage of general complications (p = 0.291), vomiting (p = 0.696) or surgical infection (p = 0.534). CONCLUSION: "Ultra-early" feeding had a high adherence by patients undergoing common general surgical procedures, and it was related to decreased infusion of postoperative fluids. Complication rates and the length of stay were similar between groups.


Assuntos
Ingestão de Líquidos , Ingestão de Alimentos , Procedimentos Cirúrgicos Eletivos , Cuidados Pós-Operatórios/métodos , Adulto , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Fatores de Tempo
19.
Aesthetic Plast Surg ; 44(5): 1937-1939, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32500322

RESUMO

In this letter, we describe an attachment on conventional headbands recommended for the postoperative period in prominent ear patients to confidently wear surgical masks without disturbing the posterior auricular incision. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Vestuário , Infecções por Coronavirus/prevenção & controle , Pavilhão Auricular/cirurgia , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cirurgia Plástica/métodos , Infecções por Coronavirus/epidemiologia , Pavilhão Auricular/anormalidades , Feminino , Humanos , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Cuidados Pós-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos
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