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1.
Surg Clin North Am ; 99(6): 1123-1140, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676052

RESUMO

Elective abdominal surgery for inflammatory bowel disease is common. Surgery for Crohn's disease is not curative, and treatment must be individualized to the disease process. Surgery for ulcerative colitis generally is curative but consideration of patient-specific factors is important for staging of the procedure and determining whether ileal pouch-anal anastomosis is appropriate.


Assuntos
Colectomia/métodos , Colite Ulcerativa/cirurgia , Doença de Crohn/cirurgia , Procedimentos Cirúrgicos Eletivos/métodos , Anastomose Cirúrgica , Colite Ulcerativa/diagnóstico , Bolsas Cólicas , Doença de Crohn/diagnóstico , Feminino , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/cirurgia , Masculino , Proctocolectomia Restauradora/métodos , Prognóstico , Medição de Risco , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(44): e17740, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689822

RESUMO

To identify independent factors associated with prolonged hospital length of stay (LOS) in elderly patients undergoing first-time elective open posterior lumbar fusion surgery.We retrospectively analyzed the data of 303 elderly patients (age range: 60-86 years) who underwent first-time elective open lumbar posterior fusion surgery at our center from December 2012 to December 2017. Preoperative and perioperative variables were extracted and analyzed for all patients, and multivariate stepwise regression analysis was used to determine the variables affecting the LOS and important predictors of LOS prolongation (P < .001).The mean age of the patients was 67.0 ±â€Š5.5 years, and the mean LOS was 18.5 ±â€Š11.8 days, ranging from 7 to 103 days. Of the total, 166 patients (54.8%) were men and 83 patients (27.4%) had extended LOS. Multiple linear regression analysis determined that age (P < .001), preoperative waiting time ≥7 days (P < .001), pulmonary comorbidities (P = .010), and diabetes (P = .010) were preoperative factors associated with LOS prolongation. Major complications (P = .002), infectious complications (P = .001), multiple surgeries (P < .001), and surgical bleeding (P = .018) were perioperative factors associated with LOS prolongation. Age (P < .001), preoperative waiting time ≥7 days (P < .001), infectious complications (P < .001), and multiple surgeries (P < .001) were important predictors of LOS prolongation.Extended LOS after first-time elective open posterior lumbar fusion surgery in elderly patients is associated with factors including age, preoperative waiting time, infectious complications, and multiple surgeries. Surgeons should recognize and note these relevant factors while taking appropriate precautions to optimize the modifiable factors, thereby reducing the LOS as well as hospitalization costs.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fusão Vertebral/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Listas de Espera
3.
BMC Surg ; 19(1): 125, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477107

RESUMO

BACKGROUND: Perioperative care in colorectal surgery is systematically defined in the Enhanced Recovery After Surgery (ERAS) protocol. The ERAS protocol improves perioperative care in a multimodal way to enhance early and safe release from the hospital. Adequate compliance to the elements of the ERAS protocol is multifactorial. There are still opportunities to improve compliance of the protocol by actively involving the patient. The main objective of this study is to investigate whether compliance of selected items in the ERAS protocol can be improved through actively involving patients in the ERAS care pathway through the use of a patient-centred mobile application. METHODS: A multicentre randomized controlled trial will be conducted. Patients undergoing elective colorectal surgery, who are 18 years or older and in possession of an eligible smartphone, will be included. Patients assigned to the intervention group will install a patient-centred mobile application to be guided through the ERAS care pathway. Patients in the control group will receive care as usual. Both groups will wear an activity tracker. The primary outcome is overall compliance to selected active elements of the ERAS protocol, as registered by the patient. Secondary outcomes include Patient Reported Outcome Measures (PROMs) such as health-related quality of life, physical activity, and patient satisfaction of received care. Care-related outcomes, such as length of hospital stay, number of complications, re-intervention, and readmission rates, will also be assessed. RESULTS: The enrolment of patients will start in the second quarter of 2019. Data collection had not begun by the time this protocol was submitted. CONCLUSION: We hypothesize that by providing patients with a patient-centred mobile application, compliance to the active elements of ERAS protocol can be improved, resulting in an increased health-related quality of life, physical activity, and patient satisfaction. TRIAL REGISTRATION: Netherlands Trial Register, NTR7314 , prospectively registered on the 9th of November 2017 ( http://www.trialregister.nl ).


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Aplicativos Móveis , Participação do Paciente , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Humanos , Tempo de Internação , Cooperação do Paciente , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Recuperação de Função Fisiológica
4.
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 77-80, sept. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1048219

RESUMO

Antecedentes y objetivo: el ayuno preoperatorio disminuye el riesgo de aspiración del contenido gástrico y sus complicaciones. Sin embargo, si es excesivo, favorece la regurgitación y el riesgo de broncoaspiración tras la inducción anestésica, así como alteraciones metabólicas e hidroelectrolíticas. Analizamos su duración, en pacientes con cirugías programadas en un hospital público de agudos. Material y métodos: se encuestó a todos los pacientes mayores de 18 años con cirugías programadas. Se recolectaron datos sobre la prescripción médica de ayuno, la hora de inducción anestésica y personales. El ayuno prescripto se comparó con las recomendaciones de las guías de la AAARBA (Asociación de Anestesia, Analgesia y Reanimación de Buenos Aires). Resultados: se reclutaron 139 pacientes, con una mediana de edad de 48 años (30; 64), 53% femeninos. La mediana del ayuno prescripto fue de 12,5 horas tanto para sólidos como para líquidos. El ayuno para sólidos que realizaron los pacientes tuvo una mediana de 14 horas, la cual resultó significativamente mayor que la prescripción (p < 0,001). En cambio, el ayuno para líquidos tuvo una mediana de 12 horas, no hallándose una diferencia significativa (p = 0,452) con lo prescripto. En comparación con la guía de la AAARBA, el ayuno prescripto excedió la recomendación para sólidos (4,5 h) y para líquidos (10,5 h). El ayuno realizado por el paciente excedió lo prescripto para sólidos (1,5 h), mientras que para líquidos fue inferior (0,5 h). Conclusión: el ayuno preoperatorio prescripto no se adecuó a las recomendaciones actuales. Las horas de ayuno realizadas por el paciente resultaron excesivas. (AU)


Background and objective: preoperative fasting reduces the risk of aspiration of gastric contents and its complications. However, if fasting is excessive, it favours regurgitation and the risk of pulmonary aspiration in patients undergoing general anaesthetic, such as metabolic and electrolyte disorders. We analysed its duration in patients with elective surgeries in public acute care hospital. Material and methodologies: patients over 18 years old with elective surgeries were surveyed. Data about medical fasting indication, time of induction of anaesthesia and personal information was collected. The prescribed fast was compared with the recommendations of the AAARBA (Association of Anaesthesia, Analgesia and Reanimation of Buenos Aires) guidelines. Results: 139 patients were gathered with a median of 48 years old (30; 64), 53% of them were female. Fasting indication median was of 12.5 h for solids and liquids. The fasting made by the patient for solids had a median of 14 h which resulted to be significantly higher to the indication (p < 0.001). By contrast, the fasting for liquids had a median of 12 h which it did not show a significant difference (p = 0.452) with the indication. In comparison with the AAARBA guideline, the fasting indication exceeded the recommendation for solids (4.5 h) and for liquids (10.5 h). The fasting made by the patient exceeded to what was indicated for solids (1.5 h) while for liquids, it was inferior (0.5 h). Conclusion: the indicated preoperative fasting was not adequate to the current recommendations. The hours of fasting made by patient were excessive. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Cuidados Pré-Operatórios/métodos , Jejum/metabolismo , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Ansiedade , Pneumonia/prevenção & controle , Cirurgia Geral/tendências , Sede , Jejum/fisiologia , Fome , Procedimentos Cirúrgicos Eletivos/métodos , Desidratação , Refluxo Laringofaríngeo/mortalidade , Refluxo Laringofaríngeo/prevenção & controle , Aspiração Respiratória de Conteúdos Gástricos/complicações , Hipoglicemia , Anestesia Geral/tendências
5.
BMC Surg ; 19(1): 103, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391112

RESUMO

BACKGROUND: Recurrence after incisional hernia repair is one of the major problems related with this operation. Our objective is to analyze the influence of abdominal wall surgery expertise in the results of the open elective repair of incisional hernia. METHODS: We have compiled the data of a cohort of patients who received surgery for an incisional hernia from July 2012 to December 2015 in a University Hospital. Data were collected prospectively and registered in the Spanish Register of Incisional Hernia (EVEREG). The short- and long-term complications between the groups of patients operated on by the Abdominal Wall Surgery (AWS) unit and groups operated on by surgeons outside of the specialized abdominal wall group (GS) were compared. RESULTS: During the study period, a total of 237 patients were operated on by the open approach (114 AWS; 123 GS). One hundred seventy-five patients completed a median follow-up of 36.6 months [standard deviation (SD) = 6]. Groups were comparable in terms of age, sex, body mass index (BMI), comorbidities, and complexity of hernia. Complications were similar in both groups. Patients in the AWS group presented fewer recurrences (12.0% vs. 28.9%; P = 0.005). The cumulative incidence of recurrence was higher in the GS group [log rank 13.370; P < 0.001; odds ratio (OR) = 37.8; 95% confidence interval (CI) = 30.3-45.4]. In the multivariate analysis, surgery performed by the AWS unit was related to fewer recurrences (OR = 0.19; 95%CI = 0.07-0.58; P < 0.001). CONCLUSION: Incisional hernia surgery is associated with better results in terms of recurrence when it is performed in a specialized abdominal wall unit.


Assuntos
Parede Abdominal/cirurgia , Competência Clínica , Procedimentos Cirúrgicos Eletivos/métodos , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Especialização , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Seguimentos , Herniorrafia/normas , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Recidiva , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(31): e16639, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374033

RESUMO

The number of elective day-case surgeries has considerably increased in recent years, especially in China. Few studies have investigated the ability of mobile applications to assist recovery for patients having undergone day-surgery; however, these studies have indicated that the use of mobile applications is cost-efficient and has a positive effect on recovery after surgery. This study aimed to evaluate the utility and efficacy of using the 317-nursing mobile application program (317NAPP) for monitoring home recovery following day-surgery involving high ligation of the hernial sac in pediatric patients.Prospective clinical study involving 2 parallel groups.Patients were randomly divided into the "intervention 317NAPP group" (n = 64) and the control group (n = 63). Patients were followed-up using the 317NAPP in the intervention group and via telephonic consultations in the control group. All patients were enrolled after being provided sufficient guidance with respect to discharge and health education. The health index, including the physiological function, ability to perform daily activities, and the injury response, was evaluated before and 24 hours after surgery. The time duration of each follow-up session was also evaluated in both groups.The preoperative (T1) health index scores were significantly higher than the postoperative (T0) ones in both groups (P = .00). The quality of recovery (T1-T0) of the intervention group (10.75 ±â€Š5.28) was better than that of the control group (11.78 ±â€Š5.16), but the differences were not significant (P = .27). In the intervention group, the follow-up time duration was significantly lower in comparison to that in the control group (P = .00).This study demonstrated that 317NAPP had a positive effect on recovery following day-surgery, and the time-duration for follow-up was shorter than that performed using telephonic consultation. Monitoring recovery using 317NAPP was safe, efficient, inexpensive, and relatively easy; therefore, it may help improve the recovery of patients having undergone day-surgery.


Assuntos
Assistência ao Convalescente/métodos , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Aplicativos Móveis , Cuidados Pós-Operatórios/métodos , Atividades Cotidianas , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Educação de Pacientes como Assunto , Estudos Prospectivos , Telefone
8.
Plast Reconstr Surg ; 144(2): 284e-297e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348366

RESUMO

LEARNING OBJECTIVES: After studying this article and viewing the video, the participant should be able to: 1. Accurately describe the relevant aesthetic anatomy and terminology for common female genital plastic surgery procedures. 2. Have knowledge of the different surgical options to address common aesthetic concerns and their risks, alternatives, and benefits. 3. List the potential risks, alternatives, and benefits of commonly performed female genital aesthetic interventions. 4. Be aware of the entity of female genital mutilation and differentiation from female genital cosmetic surgery. SUMMARY: This CME activity is intended to provide a brief 3500-word overview of female genital cosmetic surgery. The focus is primarily on elective vulvovaginal procedures, avoiding posttrauma reconstruction or gender-confirmation surgery. The goal is to present content with the best available and independent unbiased scientific research. Given this relatively new field, data with a high level of evidence are limited. Entities that may be commonly encountered in a plastic surgery practice are reviewed. The physician must be comfortable with the anatomy, terminology, diagnosis, and treatment options. Familiarity with requested interventions and aesthetic goals is encouraged.


Assuntos
Genitália Feminina/lesões , Genitália Feminina/cirurgia , Cirurgia de Readequação Sexual/métodos , Cirurgia Plástica/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Seguimentos , Humanos , Medição de Risco , Resultado do Tratamento , Vagina/lesões , Vagina/cirurgia , Vulva/lesões , Vulva/cirurgia
9.
Orthop Nurs ; 38(4): 262-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343631

RESUMO

BACKGROUND: Standardized approaches to care and care pathways for patients with joint replacement have been shown to decrease length of stay (LOS), improve patient participation in education, decrease patient anxiety while improving perception of care, and lead to overall efficiency and improved care and outcomes. PURPOSE: The purpose of this study was to determine whether implementation of a standardized bundle approach to care influenced the outcomes after total hip or total knee arthroplasty (THA or TKA). METHODS: A retrospective, quasi-experimental before- and after-design study was used to evaluate the impact of the intervention. Two hospitals implemented a standardized bundle of care for patients undergoing THA or TKA that included preoperative patient education, day of surgery mobilization, and a total joint group physical therapy session (Full Bundle). Data analyses were completed on a convenience sample of 2,200 patients who underwent THA or TKA. Outcomes data measured were LOS, discharge disposition, costs, and readmission rate. RESULTS: Patients receiving the Full Bundle had significant reduction in LOS of roughly 1 day (OR = 1.687, 95% CI [1.578, 1.797]) versus group not receiving all elements (OR = 2.706; 95% CI [2.623, 2.789]). Full Bundle patients were 6 times more likely to be discharged home compared with the Partial Bundle group (OR = 6.01, 95% CI [4.01, 9.03]). Full Bundle group had significantly lower total direct costs, F(1) = 4.06, p = .046, partial η = 0.003. There were no differences in readmission rates between the 2 groups. CONCLUSION: Patients who had all elements of the THA/TKA bundle had the best outcomes. By improving efficiencies of care through the use of the bundle, the 2 hospitals positively impacted the care and outcomes of THA and TKA patients.


Assuntos
/normas , Pacotes de Assistência ao Paciente/normas , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Idoso , Artroplastia de Quadril/métodos , Artroplastia de Quadril/normas , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/normas , Artroplastia do Joelho/estatística & dados numéricos , Distribuição de Qui-Quadrado , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacotes de Assistência ao Paciente/instrumentação , Pacotes de Assistência ao Paciente/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia
10.
Bone Joint J ; 101-B(7_Supple_C): 17-21, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256648

RESUMO

AIMS: To date, no study has demonstrated an improvement in postoperative outcomes following elective joint arthroplasty with a focus on nutritional intervention for patients with preoperative hypoalbuminaemia. In this prospective study, we evaluated differences in the hospital length of stay (LOS), rate of re-admission, and total patient charges for a malnourished patient study population who received a specific nutrition protocol before surgery. PATIENTS AND METHODS: An analytical report was extracted from the electronic medical record (EMR; Epic, Verona, Wisconsin) of a five-hospital network joint arthroplasty patient data set between 2014 and 2017. A total of 4733 patients underwent joint arthroplasty and had preoperative measurement of albumin levels: 2220 at four hospitals and 2513 at the study hospital. Albumin ≤ 3.4 g/l, designated as malnutrition, was found in 543 patients (11.5%). A nutritional intervention programme focusing on a high-protein, anti-inflammatory diet was initiated in January 2017 at one study hospital. Hospital LOS, re-admission rate, and 90-day charges were compared for differential change between patients in study and control hospitals for all elective hip and knee arthroplasty patients, and for malnourished patients over time as the nutrition intervention was implemented. RESULTS: Malnourished patients with nutritional intervention at the study hospital had shorter hospital LOS beginning in 2017 than malnourished patients at control hospitals during the same period (p = 0.04). Similarly, this cohort had significantly lower primary hospitalization charges, charges associated with hospital re-admissions, and 90-day total charges (p < 0.001). Inclusion of covariant potential confounders (age, anaemia, diabetes, and obesity) did not alter the conclusions of the primary statistical analysis. CONCLUSION: Joint arthroplasty outcomes were positively affected in study patients with low albumin when a high-protein, anti-inflammatory diet was encouraged. Elective surgery was neither cancelled nor delayed with a malnutrition designation. While the entire network population experienced improved postoperative outcomes, malnourished control patients did not experience this improvement. This study demonstrated that education on malnutrition can benefit patients. Cite this article: Bone Joint J 2019;101-B(7 Supple C):17-21.


Assuntos
Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Desnutrição/complicações , Estado Nutricional , Apoio Nutricional/métodos , Osteoartrite/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Tempo de Internação/tendências , Masculino , Desnutrição/terapia , Pessoa de Meia-Idade , Osteoartrite/complicações , Alta do Paciente/tendências , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
11.
Eur Arch Otorhinolaryngol ; 276(7): 2047-2053, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31161362

RESUMO

PURPOSE: Many authors have described clinicopathologic parameters as factors related to cervical lymph node metastasis development in CN0 stage lip cancer. However, predictive factors for occult lymph node metastasis and criteria for elective neck dissection, especially for early tumour, remain undefined. METHODS: A multi-institutional study with 193 consecutive patients with early lip SCC treated from January 1990 to March 2006 was carried out retrospectively to determine factors predicting occult metastasis. RESULTS: The overall late LNM rate was 13% (25/193). In the multivariate logistic regression study, tumour size and pattern of tumour invasion were factors related to the occurrence of late LNM with rates of sensitivity, specifity and accuracy for occult LNM prediction of 50%, 89.5% and 87%, respectively. CONCLUSION: Our results indicate that patients with stage I and II SCC of the lip with tumour size greater than 18 mm and more aggressive pattern of invasion must be considered a high-risk group for LNM and an END should be performed.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Labiais , Esvaziamento Cervical/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Neoplasias Labiais/diagnóstico , Neoplasias Labiais/patologia , Modelos Logísticos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Pescoço , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Carga Tumoral
12.
Spine (Phila Pa 1976) ; 44(13): 959-966, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205177

RESUMO

STUDY DESIGN: The enhanced perioperative care (EPOC) program is an institutional quality improvement initiative. We used a historically controlled study design to evaluate patients who underwent major spine surgery before and after the implementation of the EPOC program. OBJECTIVE: To determine whether multidisciplinary EPOC program was associated with an improvement in clinical and financial outcomes for elective adult major spine surgery patients. SUMMARY OF BACKGROUND DATA: The enhanced recovery after surgery (ERAS) programs successfully implemented in hip and knee replacement surgeries, and improved clinical outcomes and patient satisfaction. METHODS: We compared 183 subjects in traditional care (TRDC) group to 267 intervention period (EPOC) in a single academic quaternary spine surgery referral center. One hundred eight subjects in no pathway (NOPW) care group was also examined to exclude if the observed changes between the EPOC and TRDC groups might be due to concurrent changes in practice or population over the same time period. Our primary outcome variables were hospital and intensive care unit lengths of stay and the secondary outcomes were postoperative complications, 30-day hospital readmission and cost. RESULTS: In this highly complex patient population, we observed a reduction in mean hospital length of stay (HLOS) between TRDC versus EPOC groups (8.2 vs. 6.1 d, standard deviation [SD] = 6.3 vs. 3.6, P < 0.001) and intensive care unit length of stay (ILOS) (3.1 vs. 1.9 d, SD = 4.7 vs. 1.4, P = 0.01). The number (rate) of postoperative intensive care unit (ICU) admissions was higher for the TRDC n = 109 (60%) than the EPOC n = 129 (48%) (P = 0.02). There was no difference in postoperative complications and 30-day hospital readmissions. The EPOC spine program was associated with significant average cost reduction-$62,429 to $53,355 (P < 0.00). CONCLUSION: The EPOC program has made a clinically relevant contribution to institutional efforts to improve patient outcomes and value. We observed a reduction in HLOS, ILOS, costs, and variability. LEVEL OF EVIDENCE: 3.


Assuntos
Procedimentos Neurocirúrgicos/normas , Assistência Perioperatória/normas , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/economia , Procedimentos Neurocirúrgicos/métodos , Readmissão do Paciente/economia , Readmissão do Paciente/tendências , Satisfação do Paciente , Assistência Perioperatória/economia , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/economia , Melhoria de Qualidade/normas , Resultado do Tratamento
14.
Sao Paulo Med J ; 137(1): 66-74, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31116274

RESUMO

BACKGROUND: The pleural drain insertion site after coronary artery bypass graft (CABG) surgery may alter lung function, especially respiratory muscle strength. The main objective of this study was to compare the effectiveness and safety of use of the left lateral intercostal region versus the subxiphoid position for pleural drainage during elective CABG surgery using extracorporeal circulation (ECC). DESIGN AND SETTING: Randomized trial conducted in a tertiary-level hospital in Porto Alegre, Brazil. METHODS: 48 patients were assigned to group 1 (pleural drain in the left lateral intercostal region) or group 2 (pleural drain in the subxiphoid position). Respiratory muscle strength was measured in terms of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), in cmH2O, by means of manovacuometry preoperatively, 24 and 72 hours after drain removal and before discharge from hospital. Painand dyspnea scales, presence of infections, pleural effusion and atelectasis, duration of drain use, drainage volumes and surgical reinterventions were also evaluated. RESULTS: After adjustments, there were no significant differences between the groups at the end of the study (before discharge), in predicted percentages either for MIP (delta group 1: -17.21% versus delta group 2: -22.26%; P = 0.09) or for MEP (delta group 1: -9.38% versus delta group 2: -13.13%; P = 0.17). Therewere no differences between the groups in relation to other outcomes. CONCLUSION: There was no difference in maximal respiratory pressures in relation to the pleural drain insertion site among patients who underwent CABG surgery using ECC. TRIAL REGISTRATION: ReBEc V1111.1159.4447.


Assuntos
Ponte de Artéria Coronária/métodos , Drenagem/instrumentação , Drenagem/métodos , Cavidade Pleural/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Drenagem/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Circulação Extracorpórea/métodos , Feminino , Humanos , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Medição da Dor , Derrame Pleural/etiologia , Derrame Pleural/prevenção & controle , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
15.
World Neurosurg ; 122: 43-47, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31108065

RESUMO

BACKGROUND: The intraoperative use of neurophysiological monitoring (IONM) and indocyanine green video angiography (ICGVA) for aneurysm clipping have evolved during the last years. Both modalities are useful and safe by allowing greater rates of complete aneurysm occlusion with less intraoperative complications and postoperative neurologic deficits. We report a case of attempted aneurysm clipping in which the combined use of ICGVA and IONM was crucial for intraoperative decision-making. CASE DESCRIPTION: A 62-year-old woman was operated for an incidental 6-mm aneurysm at the origin of the right fronto-opercular branch. During aneurysm clipping, IONM amplitudes dropped drastically, despite patency of the parent artery and perforators in ICGVA. Several attempts for clipping were made with recurring drops in IONM amplitudes, which forced us to leave the aneurysm untreated. The patient had a postoperative left-sided hemiparesis that improved on follow-up. Thereafter, the aneurysm was treated with stent-assisted coiling. CONCLUSIONS: The combination of IONM and ICGVA during aneurysm surgery allows for a better assessment of vascular integrity and patient's postoperative outcome than ICGVA alone. Simultaneous evaluation of vessel patency and integrity of the somatosensory and motor pathways illustrates the complementarity of testing different modalities for intraoperative decision-making and for maximizing safeness in aneurysm clipping.


Assuntos
Aneurisma Intracraniano/cirurgia , Angiografia Cerebral/métodos , Corantes , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Verde de Indocianina , Aneurisma Intracraniano/diagnóstico por imagem , Monitorização Neurofisiológica Intraoperatória/métodos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento , Cirurgia Vídeoassistida/métodos
16.
Khirurgiia (Mosk) ; (4): 24-29, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31120443

RESUMO

AIM: To analyze the current state of elective surgery for peptic ulcer and to assess its significance for improving the results of treatment of this disease. MATERIAL AND METHODS: The analysis included elective procedures for peptic ulcer performed in the surgical department of Tula Regional Clinical Hospital in the period from 2011 to 2015. These data were compared with those for the period 1996-2000 in order to objectively identify current changes in surgery for peptic ulcer. The interval between both periods was 10 years. The main group consisted of 47 patients with peptic ulcer who underwent surgery in 2011-2015. The control group included 254 patients who underwent similar procedures in 1996-2000. RESULTS: Annual number of elective procedures for peptic ulcer decreased 5 times. There was advanced mean age in the main group, 29.8% of patients in the main group were older than 60 years, in the control group - 23%. Male/female ratio in the main group was 1:1, in the control group - 5:1. Prolonged ulcer history was observed in 10.6% of patients of the main group and 3.2% - in the control group. At the end of the last century, the greatest number of scheduled operations was performed for duodenal ulcer, now - for stomach ulcer. There was increased incidence of surgery for post-resection gastric syndrome (17 and 4.8% in both groups, respectively). We noted similar indications for elective surgical treatment of peptic ulcer in both groups. However, the negative feature of current period is significant augmentation of patients with decompensated pyloroduodenal stenosis. The structure of elective operations in 2011-2015 was characterized by significant proportion of decompensated complications of peptic ulcer as a result of prolonged medication. Prolonged postoperative hospital-stay and increased postoperative mortality were noted in the main group. CONCLUSION: Reduced number of elective procedures for peptic ulcer is associated with changed structure of patients undergoing surgery. Unreasonable prolonged medication aggravates patient state and adversely affects the results of surgical treatment. The current state of elective surgery for peptic ulcer does not correspond to the objective to improve the results of treatment of this disease.


Assuntos
Úlcera Duodenal/cirurgia , Úlcera Péptica/cirurgia , Úlcera Gástrica/cirurgia , Úlcera Duodenal/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/complicações , Federação Russa/epidemiologia , Úlcera Gástrica/epidemiologia
17.
Plast Reconstr Surg ; 143(6): 1738-1745, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136493

RESUMO

BACKGROUND: Various factors can influence outcomes in cleft palate care. This study sought to determine the impact of race on admissions, hospital costs, and short-term complications in cleft palate repair. METHODS: Cleft palate operations were identified in the Kids' Inpatient Database data, from 2000 to 2009. Data were combed for demographics, perioperatives, complications, and hospital characteristics. Bivariate and multivariate analyses were performed between races in total, primary, and revision cohorts. RESULTS: There were 3464 white, 1428 Hispanic, 413 black, 398 Asian/Pacific-Islander, and 470 patients of other races captured. Black patients experienced more emergent admissions (p = 0.005) and increased length of stay (p = 0.029). Hospital charges were highest for black and Hispanic patients and lowest for white patients (p = 0.019). Black patients had more total complications than non-black patients (p = 0.039), including higher rates of postoperative fistula (p = 0.020) and nonspecific complications among revision repairs (p = 0.003). Asian/Pacific Islander in the primary cohort experienced higher rates of accidental puncture (p = 0.031) and fistula (p < 0.001). Other patients had the highest rates of wound disruption (p = 0.013). After controlling for race, diagnosis, Charlson Comorbidity Index score, region, elective/nonelective, payer, and income quartile, length of stay (p < 0.001) and age (p < 0.001) were associated with increases in both total complications and costs. CONCLUSIONS: Race may play a significant role in cleft palate repair, as white patients had fewer complications, shorter length of stay, and lower costs following repair. Delayed age at treatment may predispose patients to adverse sequelae in minority populations, in terms of influencing length of stay and costs. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Fissura Palatina/etnologia , Fissura Palatina/cirurgia , Disparidades em Assistência à Saúde/etnologia , Custos Hospitalares , Procedimentos Cirúrgicos Reconstrutivos/métodos , Afro-Americanos/estatística & dados numéricos , Pré-Escolar , Fissura Palatina/diagnóstico , Estudos de Coortes , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/economia , Masculino , Análise Multivariada , Determinação de Necessidades de Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Racismo/etnologia , Racismo/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/economia , Reoperação/métodos , Estudos Retrospectivos , Estados Unidos
18.
N Engl J Med ; 380(22): 2126-2135, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31141634

RESUMO

BACKGROUND: Elective endovascular repair of an abdominal aortic aneurysm results in lower perioperative mortality than traditional open repair, but after 4 years this survival advantage is not seen; in addition, results of two European trials have shown worse long-term outcomes with endovascular repair than with open repair. Long-term results of a study we conducted more than a decade ago to compare endovascular repair with open repair are unknown. METHODS: We randomly assigned patients with asymptomatic abdominal aortic aneurysms to either endovascular repair or open repair of the aneurysm. All the patients were candidates for either procedure. Patients were followed for up to 14 years. RESULTS: A total of 881 patients underwent randomization: 444 were assigned to endovascular repair and 437 to open repair. The primary outcome was all-cause mortality. A total of 302 patients (68.0%) in the endovascular-repair group and 306 (70.0%) in the open-repair group died (hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.13). During the first 4 years of follow-up, overall survival appeared to be higher with endovascular repair than with open repair; from year 4 through year 8, overall survival was higher in the open-repair group; and after 8 years, overall survival was once again higher in the endovascular-repair group (hazard ratio for death, 0.94; 95% CI, 0.74 to 1.18). None of these trends were significant. There were 12 aneurysm-related deaths (2.7%) in the endovascular-repair group and 16 (3.7%) in the open-repair group (between-group difference, -1.0 percentage point; 95% CI, -3.3 to 1.4); most deaths occurred during the perioperative period. Aneurysm rupture occurred in 7 patients (1.6%) in the endovascular-repair group, and rupture of a thoracic aneurysm occurred in 1 patient (0.2%) in the open-repair group (between-group difference, 1.3 percentage points; 95% CI, 0.1 to 2.6). Death from chronic obstructive lung disease was just over 50% more common with open repair (5.4% of patients in the endovascular-repair group and 8.2% in the open-repair group died from chronic obstructive lung disease; between-group difference, -2.8 percentage points; 95% CI, -6.2 to 0.5). More patients in the endovascular-repair group underwent secondary procedures. CONCLUSIONS: Long-term overall survival was similar among patients who underwent endovascular repair and those who underwent open repair. A difference between groups was noted in the number of patients who underwent secondary therapeutic procedures. Our results were not consistent with the findings of worse performance of endovascular repair with respect to long-term survival that was seen in the two European trials. (Funded by the Department of Veteran Affairs Office of Research and Development; OVER ClinicalTrials.gov number, NCT00094575.).


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares , Idoso , Aneurisma da Aorta Abdominal/mortalidade , Causas de Morte , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Endovasculares/métodos , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Complicações Pós-Operatórias , Resultado do Tratamento
19.
BMC Res Notes ; 12(1): 245, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036075

RESUMO

OBJECTIVE: At present, cholecystectomy is carried out for thalassaemia patients with gall stone disease only if they develop symptoms of cholecystitis, except in the rare instance where an un-inflammed gall bladder is removed simultaneously with splenectomy. We carried out this retrospective analysis of case records to examine if patients with thalassaemia have a higher rate of peri operative complications compared to non-thalassaemics with gall stone disease, warranting a change of policy to justify elective cholecystectomy. RESULTS: Case records of 540 patients with thalassaemia were retrospectively analysed of which 98 were found to have gallstones. Records of 62 patients without thalassaemia with gall stone disease too were used for comparison. 19 of patients with thalassaemia and 52 of non-thalassaemic who had gallstones had undergone cholecystectomy. In all but 5 patients with thalassaemia cholecystectomy was done following attacks of acute cholecystitis as was the case in the non-thalassaemic controls. A significantly higher proportion of early and late complications had occurred in thalassaemia patients compared to non-thalassaemic patients post operatively. Six deaths related to sepsis following acute cholecystitis in the peri operative period were reported among 19 thalassaemia patients whereas no deaths were reported among 55 non-thalassaemic patients who underwent cholecystectomy for gallstones.


Assuntos
Colecistectomia Laparoscópica/estatística & dados numéricos , Colecistite Aguda/cirurgia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Esplenectomia/estatística & dados numéricos , Talassemia beta/cirurgia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Pré-Escolar , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/mortalidade , Colecistite Aguda/complicações , Colecistite Aguda/mortalidade , Colecistite Aguda/patologia , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/mortalidade , Feminino , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Cálculos Biliares/patologia , Cálculos Biliares/cirurgia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Baço/patologia , Baço/cirurgia , Esplenectomia/mortalidade , Análise de Sobrevida , Fatores de Tempo , Talassemia beta/complicações , Talassemia beta/mortalidade , Talassemia beta/patologia
20.
Complement Ther Clin Pract ; 35: 284-289, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31003671

RESUMO

BACKGROUND: and purpose. Complementary medicines (CM) use may result in untoward effects perioperatively. The study purpose is to identify CM pattern of use amongst elective surgery patients, and improve effectiveness of information collection relating to CM use. MATERIALS AND METHODS: This is a prospective observational cohort study. CM questionnaire was administered alongside standard hospital forms at pre-admission clinic over eight weeks. RESULTS: 992 patients attended pre-admission clinic; 317 patients were included in analysis. Introduction of CM questionnaire increased disclosure rate by 11.7% giving a total prevalence of 44.2%. CM use was significantly higher in females and in older patients. Top CM reported were vitamin D (12%) and omega-3 (12%). Majority of patients did not plan to withhold CM before surgery, and were not concerned about perioperative risks. CONCLUSION: Pre-admission clinics need to encourage CM disclosure. Patient education of potential risks and greater engagement of clinicians in patient assessment is required.


Assuntos
Terapias Complementares/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Inquéritos e Questionários , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
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