Tasa de afectación de los márgenes quirúrgicos tras la cirugía conservadora de mama y estimación de los costes directos

ObjectiveAssessment of the reoperation rate in patients with positive resection margins after initial breast-conserving surgery for breast cancer and estimation of the cost to the hospital.Method146 patients with diagnosis of invasive breast cancer were included, who were initially intervened with conservative surgery by the Gynecology and Obstetrics Service of Hospital Universitario de Tarragona Juan XXIII (HUTJ23) during the years 2018 and 2019. We calculated the rate of involvement of the surgical margins of the resection piece after initial conservative surgery, establishing in which cases it was necessary to carry out a second resection, estimating the added direct costs of the second surgical procedure, and comparing them with the costs established by the Catalan Health Service according to the level of the hospital and the Diagnosis-Related Groups (DRG) established by the National Health System.ResultsThe rate of positive margins after initial conservative surgery was 20.55% and 19.17% patients underwent reoperation, generating a total expense of € 129.696,89, € 82.654,34 in conservative surgeries (€ 3.757,01 on average per patient) and € 47.042,55 in mastectomies (€ 6.720,36 on average per patient).ConclusionsMargin involvement after breast-conserving surgery is synonymous for reoperation, this involves a series of direct costs. It is advisable to control the factors related to affected margins to minimize their impact.     

手术治疗脊柱结核病灶清除术后感染的疗效

【摘要】 目的：探讨手术治疗脊柱结核病灶清除术后合并感染的疗效分析。方法：回顾性分析2006年1月~2018年12月在我院骨科收治的因脊柱结核术后感染而再次手术的患者的资料18例，其中男性11例，女性7例，年龄27~76岁，平均46.6±18.3岁，随访12~36个月，平均18.6±6.5个月，统计合并症、首次手术方式、致病菌种类、手术时间、术中出血量、术后植骨融和情况等资料，统计手术前、术后2周以及末次随访Cobb角以及C反应蛋白（C-reactive protein，CRP）、血沉、疼痛视觉模拟评分（visual analogue scale，VAS）；根据美国脊髓损伤协会损伤分级（American Spinal Injury Association，ASIA）分析患者手术前及末次随访时的截瘫程度的变化，综合上述因素，评价手术治疗脊柱结核术后感染的疗效分析及相关风险。结果：18例患者中，感染金黄色葡萄球菌4例，大肠埃希菌3例，肺炎克雷伯菌2例，表面葡萄球菌2例，溶血性葡萄球菌2例，厌氧菌1例，铜绿假单胞菌1例，阴沟肠杆菌1例；鲍曼不动杆菌2例。14例采取了单纯后路手术，4例采取了前后路联合的手术。手术时间为97～280min，出血量为100～1200ml。患者术前血沉45.6±25.8mm/h，CRP为38.3±42.0mg/L，VAS评分为6.3±1.5分，Cobb角为15.3°±6.7°；术后2周时血沉30.3±11.0mm/h，CRP为24.1±8.9mg/L，VAS评分2.4±1.2分，Cobb角12.6°±5.8°；末次随访血沉14.2±9.6mm/h，CRP为11.6±13.2mg/L，VAS评分为1.8±1.1分，Cobb角12.8°±4.7°，均有统计学差异（P＜0.05）。1例ASIA B级患者术后恢复至D级、1例ASIA C级患者及4例ASIA D级患者末次随访时ASIA分级达到E级；有1例ASIA D级患者术后仍评为D级，但患者疼痛等症状明显恢复，生活基本自理。术后3～5个月植骨融合率100%。所有患者再次术后未见明显并发症。结论：脊柱结核术后感染的患者，经过充分抗感染、手术中彻底清除病灶、术后充分引流后，也能取得很好的治疗效果。     

Survival after reoperation for recurrent glioblastoma multiforme: A prospective study

PurposeGlioblastoma multiforme (GBM) is the most common malignant brain tumor. Moreover, GBM recurs in nearly all patients. Although a standard STUPP protocol has been widely used for newly diagnosed GBM, no standard regimen has been established for recurrent patients. Here we evaluated the clinical value of recurrent GBM reoperation by comparing overall survival and quality of life (QoL) in patients with recurrent GBM undergoing repeat surgery or conservative treatment.MethodsThis was a prospective study of 165 patients with GBM receiving first operations for their disease between 2011 and 2013 at two tertiary neurosurgery centers in Poland. Thirty-five eligible patients were re-operated for recurrence (the study group), and 35 patients were selected as the control group using propensity score matching. A model was created to determine advantageous prognostic factors for longer survival of patients qualifying for reoperation using stepwise linear regression.ResultsThe mean overall survival of patients undergoing repeat surgery was 528 days compared to 297 days in patients who did not undergo repeat surgery. Reoperation did not result in a significant deterioration in performance status as measured by the Karnofsky Performance Scale. Older age, the presence of symptoms of increased intracranial pressure, and a shorter period between initial operation and reoperation were independent predictors of a worse outcome.ConclusionIn selected patients, reoperation for recurrent GBM prolongs survival with no significant deteriorations in performance status.     

Rates of reoperation and nonoperative intervention within 30 days of bariatric surgery

BackgroundComplications arising from laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are not insignificant and can necessitate additional invasive interventions or reoperations.ObjectivesIn this study, we identify early complications that result in nonoperative and operative interventions after LSG and LRYGB, the timeframe within which to expect them, and factors that influence the likelihood of their occurrence.SettingMulti-institutional database from across North America.MethodsData for this study were obtained from Metabolic and Bariatric Accreditation and Quality Improvement Program participant use files for 2015 and 2016. Statistical analysis was performed using STATA 15. Univariate analysis using Χ² for categoric data and independent t test for continuous data was performed to determine between group differences. Multivariable logistic regression analysis was used to identify predictors of operative and nonoperative reinterventions.ResultsIn 2015 and 2016, 243,747 underwent LRYGB or LSG, of which 3013 (1.24%) required a second operative procedure and 1536 (0.63%) required an invasive but nonoperative intervention. Complications occurred in 5.48% of LRYGB patients and 2.28% of LSG patients, the most common of which was bleeding. LSG was associated with far fewer nonoperative and operative interventions (.85% versus 2.2%, respectively) than LRYGB (.67% versus 2.5%). Renal insufficiency, including dialysis dependency, was an important predictor of reoperations among bariatric surgery patients. This was also true of nonoperative interventions; however, history of pulmonary embolism, and use of therapeutic anticoagulation were marginally stronger predictors.ConclusionsIn a representative, multinational sample, operative and nonoperative interventions were half as likely among LSG patients compared with LRYGB; however, overall rates still remained low. These findings, in conjunction with new efficacy data demonstrating comparable long-term weight loss between LRYGB and LSG, provide further support for the safety, effectiveness, and cost efficiency of LSG.     

Risk factors for reoperation,readmission, and early complications after below knee amputation

Background

Many patients undergoing below knee amputations (BKA) return for subsequent unplanned operations, hospital readmission, or postoperative complications. This unplanned medical management negatively impacts both patient outcomes and our healthcare system. This study primarily investigates the risk factors for unplanned reoperation following BKA.

Complications and reoperations after surgery for 647 patients with spine metastatic disease

Background Context

Postoperative morbidity may offset the potential benefits of surgical treatment for spine metastatic disease; hence, risk factors for postoperative complications and reoperations should be taken into considerations during surgical decision-making. In addition, it remains unknown whether complications and reoperations shorten these patients' survival.

精索静脉曲张手术后患者的管理策略

手术治疗精索静脉曲张在改善精液质量、提高配偶自然怀孕率和缓解局部疼痛症状中的作用已为多数医生所认同。随着手术方式的改进,越来越多的精索静脉曲张患者接受手术治疗,然而,临床对手术后患者的管理还重视不够。本文系统介绍了对精索静脉曲张手术后患者的疗效判断和后续治疗选择,包括观察随诊、非手术治疗方法和再手术。     

肝段或肝叶切除术对肝内胆管结石再次手术效果的影响

目的对比不同术式对肝内胆管结石再次手术效果，探讨肝段或肝叶切除术的优势。 方法回顾性分析2011年8月至2014年8月收治的79例肝内胆管结石再次手术患者资料，依据术式不同分为肝段(叶)切除术组(甲组，n＝38)和非肝段(叶)切除术组(乙组，n＝41)两组。应用SPSS 19.0软件对所有临床数据进行统计学分析，手术相关指标等以( ±s)的形式表示，组间比较采用独立t检验；术后并发症发生情况及预后情况等计数资料以例(%)的形式表示，采用χ²检验；P<0.05差异有统计学意义。 结果两组患者术中出血量、手术时间及术后住院时间相比，差异无统计学意义(P>0.05)；甲组患者的术后并发症发生率5.3%(2/38)显著低于乙组22.0%(9/41)(P<0.05)；甲组残留结石发生率、症状复发率2.6%(1/38)、 0(0/41)均显著低于乙组17.1%(7/41)、 12.2%(5/41)(P<0.05)，差异有统计学意义(P<0.05)；但两组患者的病死率2.6%(1/38)和0(0/41)相比，差异无统计学意义(P>0.05)。 结论肝段(叶)切除术能够有效改善肝内胆管结石再次手术效果，值得推广。     

关节置换术后假体周围感染临床诊断与治疗的研究现状

目的 总结髋、膝关节置换术后假体周围感染(PJI)的临床诊断,以及保留假体清创术和翻修手术治疗PJI的研究现状。方法 在中国知网、万方数据、PubMed等中、英文数据库,以“假体周围感染”“诊断”“清创”“再手术”以及“periprosthetic joint infection”“diagnosi”“debridement”“reoperation”等为关键词,检索2010年1月—2020年11月关于PJI的临床诊断和治疗的相关文献共4 685篇,剔除内容不符、质量较低、证据等级不高、重复研究的文献,最终纳入45篇文献(包括中文文献5篇、英文40篇),从PJI的临床诊断和治疗现状两方面进行总结、分析。结果 近年来有关PJI的诊断技术不断出新,如新的生物学标志物研究、二代测序技术的应用,但其诊断的有效性仍值得商榷;目前对PJI的诊断仍以肌肉骨骼感染协会(MSIS)的标准为主。应用保留假体清创术和一期翻修术治疗早期PJI的成功率较高,患者术后功能恢复较好;对于晚期感染、微生物培养为阴性和真菌性PJI,二期翻修术效果更佳。结论 PJI的预防和早期诊断治疗非常重要。在MSIS诊断标准基础上,通过优化现有检测方式、结合多种诊断方法,可提高诊断PJI的准确性。对于早期PJI患者,建议行保留假体清创术和一期翻修术治疗;而对于晚期感染、微生物培养为阴性、真菌性PJI患者,建议行二期翻修术治疗。