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1.
Am Surg ; 86(1): 21-27, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32077412

RESUMO

Hospital-acquired conditions (HACs) are used to define hospital performance measures. Patient comorbidity may influence HAC development. The National Inpatient Sample database was used to investigate HACs for the patients who underwent liver transplantation. Multivariate analysis was used to identify HAC risk factors. We found a total of 13,816 patients who underwent liver transplantation during 2002-2014. Of these, 330 (2.4%) had a report of HACs. Most frequent HACs were vascular catheter-associated infection [220 (1.6%)], falls and trauma [66 (0.5%), catheter-associated UTI [24 (0.2%)], and pressure ulcer stage III/IV [22 (0.2%)]. Factors correlating with HACs included extreme loss function (AOR: 52.13, P < 0.01) and major loss function (AOR: 8.11, P = 0.04), hepatopulmonary syndrome (AOR: 3.39, P = 0.02), portal hypertension (AOR: 1.49, P = 0.02), and hospitalization length of stay before transplant (AOR: 1.01, P < 0.01). The rate of HACs for liver transplantation is three times higher than the reported overall rate of HACs for GI procedures. Multiple patient factors are associated with HACs, and HACs may not be a reliable measure to evaluate hospital performance. Vascular catheter-associated infection is the most common HAC after liver transplantation.


Assuntos
Doença Iatrogênica/epidemiologia , Transplante de Fígado , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Fatores de Risco , Estados Unidos/epidemiologia
2.
Medicine (Baltimore) ; 99(2): e18539, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914027

RESUMO

The purpose of this study was to determine the factors associated with parenteral nutrition-associated liver disease (PNALD) in infants who underwent surgery for necrotizing enterocolitis (NEC) and followed up the postoperative outcomes for long term parenteral nutrition (PN).This study included a retrospective review of 87 infants with NEC and managed surgically from July 2007 to May 2017 at the Children's Hospital, Chongqing Medical University. Clinical data and procedure information were collected and analyzed.Among the infants included, 16.1% of patients developed PNALD. Multivariable logistic regression analysis revealed progressive clinical deterioration (OR, 5.47; 95% CI, 1.10-26.96; P = .037) was independent risk factor for PNALD whereas congenital heart disease (OR, 0.068; 95% CI, 0.008-0.55; P = .012) presentation served as a protective factor.The current data suggested the distinct disease process for cardiac patients with NEC, which might help in the prevention and treatment of PNALD for patients with NEC.


Assuntos
Enterocolite Necrosante/complicações , Enterocolite Necrosante/cirurgia , Hepatopatias/etiologia , Nutrição Parenteral/efeitos adversos , Enterocolite Necrosante/dietoterapia , Enterocolite Necrosante/mortalidade , Feminino , Idade Gestacional , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/mortalidade , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Incidência , Lactente , Recém-Nascido , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco
4.
Medicine (Baltimore) ; 98(41): e17553, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593138

RESUMO

RATIONALE: Intraspinal anesthesia, the most common anesthesia type of orthopedic operation, is regarded as safe and simple. Despite of the rare incidence, puncture related complication of intraspinal anesthesia is catastrophic for spinal cord. Here we present an intradural hematoma case triggered by improper anesthesia puncture. The principal reason of this tragedy was rooted in the neglect of spine deformities diagnosis before anesthesia. To the best of our knowledge, there is no specific case report focusing on the intradural hematoma triggered by improper anesthesia puncture. PATIENT CONCERNS: Hereby a case of thoracolumbar spinal massive hematoma triggered by intraspinal anesthesia puncture was reported. The presenting complaint of the patient was little neurologic function improvement after surgery at 6-month follow-up. DIAGNOSES: Emergency MRI demonstrated that massive spindle-like intradural T2-weighted image hypointense signal masses from T12 to S2 badly compressed the dural sac ventrally, and his conus medullaris was at L3/4 intervertebral level with absence of L5 vertebral lamina. Hereby, the diagnoses were congenital spinal bifida, tethered cord syndrome, spine intradural hematoma, and paraplegia. INTERVENTIONS: Urgent surgical interventions including laminectomy, spinal canal exploration hematoma removal, and pedicle fixation were performed. The patient received both medication (mannitol, mecobalamin, and steroids) and rehabilitation (neuromuscular electric stimulation, hyperbaric oxygen). OUTCOMES: Postoperation, he had regained only hip and knee flexion at II grade strength. His neurologic function was unchanged until 3 weeks postoperation. Six-month follow-up showed just little neurologic function improvement, and the American Spinal Injury Association grade was C. LESSONS: By presenting an intradural hematoma case triggered by improper anesthesia puncture, we shared the treatment experience and discussed the potential mechanism of neurologic compromise. The principal reason for this tragedy is preanesthesia examination deficiency. Necessary radiology examinations must be performed to prevent misdiagnosis for spinal malformation.


Assuntos
Anestesia/efeitos adversos , Hematoma/etiologia , Punções/efeitos adversos , Adulto , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Hematoma/diagnóstico por imagem , Hematoma/patologia , Hematoma/cirurgia , Humanos , Doença Iatrogênica/epidemiologia , Injeções Espinhais , Laminectomia/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Medula Espinal/irrigação sanguínea , Medula Espinal/patologia , Doenças da Medula Espinal/patologia , Coluna Vertebral/anormalidades , Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
5.
Crit Care ; 23(1): 278, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399052

RESUMO

BACKGROUND: As many as 90% of patients develop anemia by their third day in an intensive care unit (ICU). We evaluated the efficacy of interventions to reduce phlebotomy-related blood loss on the volume of blood lost, hemoglobin levels, transfusions, and incidence of anemia. METHODS: We conducted a systematic review and meta-analysis using the Laboratory Medicine Best Practices (LMBP) systematic review methods for rating study quality and assessing the body of evidence. Searches of PubMed, Embase, Cochrane, Web of Science, PsychINFO, and CINAHL identified 2564 published references. We included studies of the impact of interventions to reduce phlebotomy-related blood loss on blood loss, hemoglobin levels, transfusions, or anemia among hospital inpatients. We excluded studies not published in English and studies that did not have a comparison group, did not report an outcome of interest, or were rated as poor quality. Twenty-one studies met these criteria. We conducted a meta-analysis if > 2 homogenous studies reported sufficient information for analysis. RESULTS: We found moderate, consistent evidence that devices that return blood from flushing venous or arterial lines to the patient reduced blood loss by approximately 25% in both neonatal ICU (NICU) and adult ICU patients [pooled estimate in adults, 24.7 (95% CI = 12.1-37.3)]. Bundled interventions that included blood conservation devices appeared to reduce blood loss by at least 25% (suggestive evidence). The evidence was insufficient to determine if these devices reduced hemoglobin decline or risk of anemia. The evidence suggested that small volume tubes reduced the risk of anemia, but was insufficient to determine if they affected the volume of blood loss or the rate of hemoglobin decline. CONCLUSIONS: Moderate, consistent evidence indicated that devices that return blood from testing or flushing lines to the patient reduce the volume of blood loss by approximately 25% among ICU patients. The results of this systematic review support the use of blood conservation systems with arterial or venous catheters to eliminate blood waste when drawing blood for testing. The evidence was insufficient to conclude the devices impacted hemoglobin levels or transfusion rates. The use of small volume tubes may reduce the risk of anemia.


Assuntos
Anemia/prevenção & controle , Flebotomia/métodos , Anemia/epidemiologia , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Flebotomia/normas , Flebotomia/tendências , Guias de Prática Clínica como Assunto
6.
Early Hum Dev ; 137: 104836, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31437732

RESUMO

BACKGROUND: Iatrogenic gastrointestinal perforations are rare, but life-threatening events in preterm infants. AIM: Aim of the study was to report on incidence, management, morbidity, and mortality. STUDY DESIGN: This was a retrospective analysis performed at a tertiary neonatal intensive care unit in Vienna, Austria. SUBJECTS: Extremely low birth weight infants (ELBW, birth weight < 1000 g) with perforations of the upper gastrointestinal tract (GIT) caused by gastric tubes were included. OUTCOME MEASURES: All ELBW infants born within the 6-year study period were identified and their discharge summaries or notes were screened for esophageal and gastric perforations. Data on incidence, management of GIT perforations, morbidity, and mortality were obtained. RESULTS: During a 6-year study period 646 ELBW infants were analyzed. Incidence of perforations was 1.1% (n = 7/646). Median gestational age was 23 + 3 (range: 23 + 0-24 + 5). Perforations occurred on the third day of life (=median, range: day 2-14) and were primarily managed conservatively. Enteral feeding was stopped for 6 days (range: 4-13 days), antibiotic therapy administered for 16 days (range: 8-22 days). In one infant, gastrorrhaphy was performed. CONCLUSIONS: Conservative treatment of upper GIT perforations led to spontaneous recovery without major complications in 85.7%.


Assuntos
Nutrição Enteral/efeitos adversos , Perfuração Esofágica/terapia , Doença Iatrogênica/epidemiologia , Recém-Nascido de muito Baixo Peso , Perfuração Intestinal/terapia , Áustria , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Perfuração Esofágica/epidemiologia , Perfuração Esofágica/etiologia , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Masculino , Morbidade
7.
Surgery ; 166(4): 698-702, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31439402

RESUMO

BACKGROUND: Bile duct injury during laparoscopic cholecystectomy persists as a significant problem in general surgery, resulting in complex injuries, arterial damage, and post repair strictures. METHODS: We performed a retrospective analysis between 2 eras of bile duct injury repairs: 1987 to 2001 (n = 58) and 2002 to 2016 (n = 52) using logistic regression analyses to assess presentation, repair complexity, and outcomes. RESULTS: No differences in demographics, incidence of cholecystitis, conversion, time to presentation, level of injury, or arterial injury were identified. The second era had an increase in patient age, transhepatic catheter use, prior repair, and utilization of complex repairs. This approach resulted in equivalent complications and mortality rates with increased resource utilization but a lesser incidence of post-repair strictures (P = .004). Regression modeling correlated strictures to prior operative repairs (OR 4.25; P = .016) and a protective effect of repairs performed in the second era (OR 0.23; P = .045). CONCLUSION: The second era identified a decreasing trend of attempted repairs by referring surgeons but an increase in transhepatic catheters and complex repairs resulting in lesser rates of post-repair stricture. Final regression modeling confirmed increased operative experience decreased post-repair stricture reaffirming the benefits of early identification and referral of bile duct injuries to an experienced hepatobiliary surgeon at a specialty center.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Doença Iatrogênica/epidemiologia , Complicações Intraoperatórias/cirurgia , Adulto , Idoso , Ductos Biliares/cirurgia , Colecistectomia Laparoscópica/métodos , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Complicações Intraoperatórias/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
8.
J Clin Exp Hematop ; 59(2): 48-55, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257345

RESUMO

In the current revised 4th edition of the World Health Organization (WHO) classification, 'other iatrogenic immunodeficiency-associated lymphoproliferative disorders (Oii-LPDs)' is listed in the last section in the chapter on immunodeficiency-associated lymphoproliferative disorders. Oii-LPDs cover a broad spectrum from benign lesions to lymphoma, and correspond to one of the subtypes in the WHO classification for immunocompetent patients.The WHO classification does not clearly indicate the histological subtype of this disease category; however, the framework of subtype classification is similar to the classification of post-transplant lymphoproliferative disorders, and recent studies have attempted to subcategorize Oii-LPDs that fit this unique disease type. In this review, we provide an overview of B-cell-type Oii-LPDs regarding their histopathology and immunophenotype, genetics and clinical behaviors.


Assuntos
Linfócitos B/patologia , Síndromes de Imunodeficiência/patologia , Imunossupressores/efeitos adversos , Transtornos Linfoproliferativos/patologia , Animais , Linfócitos B/efeitos dos fármacos , Humanos , Doença Iatrogênica/epidemiologia , Síndromes de Imunodeficiência/induzido quimicamente , Síndromes de Imunodeficiência/classificação , Transtornos Linfoproliferativos/induzido quimicamente , Transtornos Linfoproliferativos/classificação
9.
J Clin Exp Hematop ; 59(2): 56-63, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257346

RESUMO

Other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPDs) with a T- or NK-cell phenotype are markedly rare, with only a limited number of cases having been reported thus far. Methotrexate (MTX) is the most common agent used for OIIA-LPD patients, and 43 cases of MTX-associated T-LPDs (MTX T-LPDs) and five cases of MTX-associated NK/T-LPDs (MTX NK-LPDs) have been described. In addition to MTX T-LPDs and MTX NK/T-LPDs, T-LPD and NK/T-LPDs have been reported in patients receiving other immunosuppressive agents such as thiopurines, TNF antagonists, and cyclosporine. Hepatosplenic T-cell lymphoma (HSTL) is specifically associated with iatrogenic immunodeficiency, and 10% of HSTL cases develop in patients receiving thiopurines and/or TNF antagonists for inflammatory bowel disease (IBD). In this review, we focused on MTX T-LPD, MTX NK/T-LPD, and HSTL in patients with IBD. These T- and NK/T-cell associated OIIA-LPDs are the most common in daily medical practice.


Assuntos
Síndromes de Imunodeficiência/patologia , Transtornos Linfoproliferativos/patologia , Linfócitos T/patologia , Animais , Humanos , Doença Iatrogênica/epidemiologia , Síndromes de Imunodeficiência/induzido quimicamente , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Transtornos Linfoproliferativos/induzido quimicamente , Metotrexato/efeitos adversos , Metotrexato/uso terapêutico , Células T Matadoras Naturais/efeitos dos fármacos , Células T Matadoras Naturais/patologia , Linfócitos T/efeitos dos fármacos
10.
J Clin Exp Hematop ; 59(2): 72-92, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257348

RESUMO

Other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD), a category of immunodeficiency-associated LPD according to the World Health Organization classification, is associated with immunosuppressive drugs (ISDs). Several factors, including autoimmune disease (AID) activity, Epstein-Barr virus (EBV) infection, ISD usage, and aging, influence the development of OIIA-LPD, resulting in complicated clinical courses and outcomes. Most OIIA-LPD develops in patients with rheumatoid arthritis using methotrexate (MTX-LPD). The management of MTX-LPD is based on the clinical course, i.e., with/without regression, with/without relapse/regrowth event (RRE), LPD subtype, and ISDs for AIDs after LPD development. There are three clinical courses after ISD withdrawal: regressive LPD without relapse/regrowth (R-G), regressive LPD with RRE (R/R-G), and persistent LPD (P-G). The majority of EBV+ diffuse large B-cell lymphomas are classified in R-G, whereas classic Hodgkin lymphoma is generally classified in R/R-G. Polymorphic LPD (P-LPD) in MTX-LPD develops with heterogeneous pathological features similar to monomorphic LPD. Chemotherapy for MTX-LPD is selected according to that for de novo LPD, although the strategy for aggressive P-LPD and non-specific LPD is not well established. The absolute lymphocyte count in the peripheral blood has been suggested as a candidate marker for MTX-LPD development and RRE. Several clinical issues, including correct diagnosis among overlapping clinicopathological features in MTX-LPD and clinical management of LPD by ISDs other than MTX, require further investigation.


Assuntos
Síndromes de Imunodeficiência/terapia , Transtornos Linfoproliferativos/terapia , Animais , Artrite Reumatoide/tratamento farmacológico , Gerenciamento Clínico , Humanos , Doença Iatrogênica/epidemiologia , Síndromes de Imunodeficiência/induzido quimicamente , Síndromes de Imunodeficiência/patologia , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Transtornos Linfoproliferativos/induzido quimicamente , Transtornos Linfoproliferativos/patologia , Metotrexato/efeitos adversos , Metotrexato/uso terapêutico
11.
J Wound Ostomy Continence Nurs ; 46(4): 298-304, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274857

RESUMO

Root cause analysis (RCA) is a systematic process for identifying the causes of an adverse occurrence or combined with an approach for a response designed to prevent recurrences. This method may be used for continuous quality improvement in a facility or health system. Root cause analysis can aid nurses and hospital risk managers to determine how the system can improve to reduce the number and severity of pressure injuries. The process of RCA begins with being certain the wound is a pressure injury using differential diagnoses of similar appearing skin disease and injury, followed by an examination of the processes of care (human roots) for missed actions or inactions that are linked to development of a particular pressure injury. The final step of RCA is a critical examination of the system (including people and processes) to look for modifiable trends or patterns are identified that are used to prevent recurrences.


Assuntos
Lesão por Pressão/etiologia , Análise de Causa Fundamental/métodos , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Pessoa de Meia-Idade , Lesão por Pressão/classificação , Lesão por Pressão/epidemiologia , Melhoria de Qualidade , Análise de Causa Fundamental/classificação , Estados Unidos/epidemiologia
12.
14.
Gen Hosp Psychiatry ; 59: 37-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141759

RESUMO

OBJECTIVE: A systematic review of the literature on the risks of developing iatrogenic opioid use disorders in chronic pain patients with psychiatric comorbidity. METHODS: We conducted literature searches on Pubmed with key subjects: "chronic pain", "psychiatry", "opioids" and "opioid use disorder" and for original, English written articles published from 2000 until the first of September 2017. Final selection of the articles for review was made in a consensus between three reviewers. RESULTS: Longitudinal studies showed a significant association between psychiatric comorbidity, especially depression and anxiety disorders and the development of problematic opioid use, more severe opioid craving and poor opioid treatment outcome (analgesia and side effects) in chronic pain patients. Cross-sectional studies showed a similar association between psychiatric disorders and problematic opioid use, where studies in specialized pain settings showed a higher prevalence of psychiatric disorders, compared to non-specialized settings. CONCLUSIONS: This systematic review showed a significant association between psychiatric comorbidity, especially depression and anxiety disorders and the development of problematic opioid use in chronic pain patients. We therefore recommend psychiatric screening in chronic pain management. Chronic pain patients with comorbid psychiatric disorders need a multidisciplinary approach and monitoring opioid use is warranted in these patients.


Assuntos
Transtornos de Ansiedade/epidemiologia , Dor Crônica/epidemiologia , Comorbidade , Transtorno Depressivo/epidemiologia , Doença Iatrogênica/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Humanos
16.
J BUON ; 24(2): 431-435, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31127987

RESUMO

PURPOSE: To assess outcomes of surgical management for iatrogenic colonic perforations and risk factors of worse outcome. METHODS: We reviewed the medical records of patients with colonic perforations during colonoscopies 2007 - 2016 at the National Cancer Institute. We collected patient demographic data, colonoscopic reports, perforations treatment and outcome. RESULTS: Perforation rate was 0.14% (23 of 16 186). Twenty were managed surgically. The most common location of perforation was the sigmoid colon in 12 cases (60%). The most used surgical technique was simple suture (11 cases - 55%), followed by resection with anastomosis (6 - 30%), and Hartman's procedure in 3 cases (15%). Postoperative morbidity and mortality rates were 45% and 15% - three patients died. No significant relationship between time to surgery (p=0.285), American Society of Anaesthesiologists (ASA) score (p=0.642) or patient age (p=0.964) and postoperative complication were found. CONCLUSIONS: Patients need to be informed of the complications of colonoscopy. We could not determine strong risk factors for worse outcomes.


Assuntos
Doenças do Colo/patologia , Colonoscopia/efeitos adversos , Doença Iatrogênica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Colo/patologia , Colo/cirurgia , Doenças do Colo/diagnóstico , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Feminino , Humanos , Doença Iatrogênica/prevenção & controle , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/patologia , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Fatores de Risco
17.
Obstet Gynecol ; 133(5): 888-895, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30969213

RESUMO

OBJECTIVE: To compare the rate of delayed 30-day lower genitourinary tract injury in women who underwent cystoscopy at the time of hysterectomy for benign indications to those who did not. METHODS: This was a retrospective cohort study of patients who underwent hysterectomy without a concomitant procedure for prolapse or incontinence for benign pathology with a general obstetrician-gynecologist (ob-gyn) recorded in the National Surgical Quality Improvement Program targeted hysterectomy file between 2015 and 2017. The primary outcome was a delayed lower genitourinary tract injury in the 30 days after hysterectomy. Secondary outcomes included urinary tract infection and operative time. The exposure of interest was cystoscopy at the time of hysterectomy. Stratified analysis was performed by route of surgery. Bivariable tests were used to examine associations. RESULTS: We identified 39,529 women who underwent hysterectomy for benign indications with a general ob-gyn. Surgical approach was open (26%), laparoscopic or robotic assisted laparoscopic (46%), and vaginal or vaginally assisted (28%). Overall, 25% of women underwent cystoscopy at the time of hysterectomy; cystoscopy was more commonly performed in laparoscopic or robotic (32%) and vaginal hysterectomy (25%) as compared with open hysterectomy (11%) (P<.001). There was no difference in delayed lower genitourinary tract injury between patients who underwent cystoscopy at time of hysterectomy compared with those who did not undergo cystoscopy (0.27% vs 0.24%, P=.64). Patients who underwent cystoscopy were more likely to be diagnosed with a urinary tract infection (2.6% vs 2.0%, RR 1.27 95% CI 1.09-1.47). Median operative time was increased by 17 minutes in cases where cystoscopy was performed (132 vs 115 minutes, P<.001). CONCLUSION: Cystoscopy at the time of hysterectomy for benign indications does not result in a lower rate of 30-day delayed lower genitourinary tract injury compared with no cystoscopy.


Assuntos
Cistoscopia/efeitos adversos , Histerectomia Vaginal/efeitos adversos , Sintomas do Trato Urinário Inferior/epidemiologia , Ureter/lesões , Bexiga Urinária/lesões , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Sintomas do Trato Urinário Inferior/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
18.
Arch Orthop Trauma Surg ; 139(9): 1193-1201, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30874896

RESUMO

BACKGROUND: Total joint arthroplasty (TJA) is a major orthopedic procedure associated with substantial morbidity and mortality. Never events (NEs) are harmful hospital-acquired conditions (HACs) that are preventable. METHODS: Information on hospital admissions with TJA was collected from the National Inpatient Sample (NIS) from 2003 to 2012. NIS was queried to identify NE applicable to TJA patients based on the HAC definition listed by the Centers for Medicare and Medicaid Services (CMS). NEs were further compared before and after 2008 to evaluate the effect of the new CMS non-reimbursement policy on their incidence. RESULTS: A total of 8,176,774 patients were admitted with TJA from 2003 to 2012. 108,668 patients of these (1.33%) had ≥ 1 NE. The most prevalent NE was fall and trauma (0.7%). Significant multivariable predictors with higher odds of developing at least one NE included weekend admission [odds ratio (99.9% CI), 4.3 (3.1, 5.8), p < 0.001] and weight loss [odds ratio (99.9% CI), 2.8 (2.2, 3.5), p < 0.001]. A temporal comparison of NE before and after 2008 revealed a decrease in total NE occurrence after 2008 when the CMS announced discontinuing payment for NE (1.39% vs. 1.25%, p < 0.001). After adjustment for potential confounding risk factors, NE after TJA was significantly associated with an increased mortality (p < 0.001), a longer hospital stay (p < 0.001), and higher total hospitalization charges (p < 0.001). CONCLUSIONS: These data demonstrated that NE in TJA patients was predictive of an increased mortality, length of hospital stay, and hospitalization costs. This study established baseline NE rates in the TJA patient population to use as benchmarks and identified target areas for quality improvement in US.


Assuntos
Artroplastia , Doença Iatrogênica/epidemiologia , Erros Médicos/estatística & dados numéricos , Artroplastia/efeitos adversos , Artroplastia/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Humanos , Prevalência , Estados Unidos/epidemiologia
19.
World Neurosurg ; 126: e1050-e1054, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30878743

RESUMO

BACKGROUND: The overall incidence of iatrogenic vertebral artery injury (IVAI) in cervical spine surgeries (CSSs) is reported to be 0.07%-1.4%. Although IVAI occurred during C1-2 fusion, there is no accurate information regarding the surgery-specific risk of IVAI. This study aimed to stratify incidence of IVAI by surgical method and evaluate the correlation between IVAI and its sequelae. METHODS: This retrospective, multicenter study involved clinical and radiologic evaluations for IVAI. All CSSs performed between 2012 and 2016 were included; neck mass excision and pain intervention were excluded. Patient characteristics, diagnosis, surgical technique, complications, and presence of IVAI were collected. In IVAI cases, technique details, characteristics, and sequelae were investigated. RESULTS: This study included 14,722 patients with 15,582 CSSs in 21 centers. IVAIs were identified in 13 (0.08%) patients. Surgery-specific incidence of IVAI was 1.35% in cases involving C1-2 posterior fixation and 0.20% in cases involving C3-6 posterior fixation. Common injury mechanisms were screw-in (31%) and high-speed drilling (23%). Screw-related IVAI occurred in 9 (69%) patients, and IVAI of the C1 lateral mass and C2 pedicle screws occurred in 4 and 3 patients, respectively. Of 13 cases of IVAI, 3 (23%) involved cerebellar or stem infarction; the infarction had no substantial correlation with injury grade or dominancy. CONCLUSIONS: Overall incidence of IVAI in CSSs was 0.08%. C1-2 posterior fixation had the highest incidence of IVAI (1.35%). Although clinical results of IVAI can be highly variable, controlling risk factors of IVAI is important.


Assuntos
Doença Iatrogênica/epidemiologia , Fusão Vertebral/efeitos adversos , Artéria Vertebral/lesões , Adulto , Idoso , Vértebras Cervicais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
Rev Bras Enferm ; 72(1): 299-303, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916298

RESUMO

OBJECTIVE: To discuss the potentialities of using the concept of vulnerability to support measures for preventing and controlling healthcare-associated infections (HAIs). METHODS: This theoretical study was conducted in steps: 1) presentation of markers that frame the concept of vulnerability; 2) presentation of the characteristics of the health events to which the concept of vulnerability is intended to be applied; 3) identification of research gaps that could be potentially filled by using the concept of vulnerability; 4) identification of the potentialities of using the concept of vulnerability to deal with HAIs. RESULTS: Proposal of a framework for analyzing HAIs from a vulnerability perspective, including the individual and collective dimensions. CONCLUSION: Using the concept of vulnerability to study and deal with HAIs favors a new approach to an old problem, unlike the dominant studies that highlight the individual aspects of the practices in healthcare services.


Assuntos
Doenças Transmissíveis/classificação , Doença Iatrogênica/prevenção & controle , Populações Vulneráveis , Brasil/epidemiologia , Doenças Transmissíveis/epidemiologia , Direitos Humanos , Humanos , Doença Iatrogênica/epidemiologia , Fatores de Risco
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