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1.
Jae-Hwi Nho Young-Kyun Lee Yeon Soo Kim Yong-Chan Ha You-Sung Suh Kyung-Hoi Koo 《Journal of orthopaedic science》2014,19(5):756-761
Background
History of stroke is a risk factor for hip fracture. We investigated one-year mortality and change of mobility differences between stroke patients and non-stroke patients after hip-fracture surgery.Methods
We retrospectively evaluated 548 patients who had hip-fracture surgery from May 2003 to Dec 2008 and were older than 50 years at the time of surgery. We identified 77 patients with a history of stroke and 471 patients with no history of stroke. We compared postoperative change of mobility and 1-year mortality for the two groups.Results
Although stroke patients had lower preinjury mobility (p < 0.001) and higher American Society of Anesthesiologists score (p < 0.001), 1-year mortality and the decrease of mobility were similar to those for non-stroke patients.Conclusions
History of stroke did not affect 1-year mortality and the decrease of mobility after hip fracture.Level of evidence
Therapeutic level III. 相似文献2.
Fahad S. Hossain Rohit Rambani Helen Ribee Lutz Koch 《Journal of orthopaedics and traumatology》2013,14(3):171-177
Background
An increasing number of elderly patients are managed with long-term antiplatelet therapy. Such patients often present with hip fracture requiring surgical intervention and may be at increased risk of perioperative bleeding and complications. The aim of this study was to ascertain whether it is necessary to stop clopidogrel preoperatively to avoid postoperative complications following hip hemiarthroplasty surgery in patients with intracapsular hip fracture.Materials and methods
A retrospective review of 102 patients with intracapsular hip fracture with either perioperative clopidogrel therapy [clopidogrel group (CG)] or no previous clopidogrel exposure [no clopidogrel group (NCG)] who underwent hip hemiarthroplasty surgery was undertaken. Statistical comparison on pre- and postoperative haemoglobin, American Society of Anesthesiologists (ASA) grade, comorbidities, operative time, transfusion requirements, hospital length of stay (LOS), wound infection, haematoma and reoperation rate between the two groups was undertaken. Regression analysis was undertaken to ascertain the risk ratios (RR) of complications and transfusion associated with clopidogrel.Results
There was no difference with respect to ASA grade, comorbidities (except cardiac comorbidities), pre- and postoperative haemoglobin levels, operation time, age or gender between the two groups. Four and two patients, respectively, required transfusion postoperatively in the CG and NCG (p = 0.37). There was no difference with respect to LOS, wound infection, haematoma or reoperation rate between the two groups postoperatively. The covariate-adjusted RR for complications and transfusion while being on clopidogrel were 0.43 [95 % confidence interval (CI) 0.07–2.60] and 3.96 (95 % CI 0.40–39.68), respectively.Conclusion
Continuing clopidogrel therapy throughout the perioperative period in patients with intracapsular hip fracture is not associated with an increased risk of complications following hip hemiarthroplasty surgery. 相似文献3.
Kerem Bilsel Mehmet Erdil Deniz Gulabi Mehmet Elmadag Omer Cengiz Cengiz Sen 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2013,23(8):895-900
Purpose
To determine the effect of patient and surgical factors on mortality after hip fracture surgery.Design
Retrospective study.Setting
Level-one trauma and tertiary referral centers.Methods
Patients were eligible if they were aged 65 years or older and had undergone surgery for a non-pathological femoral neck or intertrochanteric hip fracture between 2008 and 2011. The primary outcome was mortality: within the first year after surgery, after the first year, and survival as of the last questioning date. Of the 578 eligible patients, 399 (69 %) were women; mean age was 79 years; and mean follow-up was 17 months.Results
Mortality during the first year was significantly more frequent in patients aged 80 years or older (67 vs. 33 %; P < 0.001). Estimated overall survival was significantly longer in women (43 vs. 37 %; P = 0.01). The type of fracture had no impact on mortality (P = 0.96). Patients with high ASA class had a significant effect on mortality (P < 0.001). Surgery timing did not affect mortality in univariate analysis (P = 0.25). The mortality rate for hemiarthroplasty was higher than osteosynthesis options (P = 0.03). The effect of the type of anesthesia on mortality was not significant (P = 0.74).Conclusions
Older men had the highest risk of mortality within the first year. Patients with ASA ratings of class 3 or 4 need to be evaluated carefully because they appear to be at higher risk of early mortality. Osteosynthesis has a lower mortality than does arthroplasty for hip fracture and thus should be preferred if either treatment is possible.Level of evidence
IV. 相似文献4.
Roland Biber Katrin Singler Marco Curschmann-Horter Susanne Wicklein Cornel Sieber Hermann Josef Bail 《Archives of orthopaedic and trauma surgery》2013,133(11):1527-1531
Purpose
To evaluate changes in hospital length-of-stay and time-to-operation of older hip fracture patients before and after the foundation of a co-managed Geriatric Fracture Center (GFC).Methods
A co-managed GFC was established in a German level-1 trauma center. In a retrospective cohort study, we analyzed femoral neck fracture patients >60 years treated with hemiarthroplasty. Patients treated within the first year after foundation of the GFC were compared to the patients treated during the year before. One-way ANOVA was performed to identify differences regarding time-to-operation and hospital length-of-stay.Results
One hundred and fourteen patients of the GFC were compared to 169 patients previously treated without co-management. Mean patient age did not significantly differ (81.9 vs. 81.5 years; p = 0.7), nor did gender distribution. Hospital length-of-stay was significantly shorter after foundation of the GFC (13.9 vs. 16.8 days; p = 0.007). The same is true for the interval between hospital admission and operation, which decreased from 3.1 to 2.1 days (p = 0.029). Early surgical complication rate was not significantly affected by GFC foundation (7.7 % pre-GFC vs. 9.6 % GFC; p = 0.6), nor was inpatient mortality (5.9 % pre-GFC vs. 4.4 % GFC; p = 0.6). Subgroup analysis revealed that GFC patients without early surgical complications displayed a reduced length-of-stay (LOS), whereas LOS was even prolonged in GFC patients with surgical complications.Conclusions
A co-managed GFC offering an organized fracture program for the elderly can reduce hospital length-of-stay and time-to-operation in hip fracture patients. A significant effect can be observed within the first year after establishment of a GFC. 相似文献5.
Background
Only a little is known about whether type of surgical intervention has an effect on mortality of these patients. Our primary objective was to assess whether different type of surgical procedures has an effect on mortality among elderly patients with hip fracture. A secondary objective was to examine factors that are related to mortality in our patient population. Our hypothesis is that type of surgical procedure, especially external fixation, should have an influence on mortality outcomes.Methods
We included 785 patients age 65 years or older, with hip fractures. Operative treatment consisted of external fixation, internal fixation, total hip arthroplasty and hip hemiarthroplasty. Age, gender, type of fracture, type of surgery performed, American Society of Anesthesiology (ASA) grade, clinical comorbidities, anesthesia type, blood transfusion requirement, time to surgery, intensive care unit requirement, operation length and length of hospital stay and number of comorbidities were documented.Results
During the study period, 785 patients (262 male, 523 female) were included to study, Overall mortality rate was 37.2 % (292/785). Their age ranged between 65 and 100 years (mean 81). Surgery type Kaplan–Meier cumulative mortality curves suggested no significant difference between four different types of surgery groups (p = 0.064). Transfusion requirement was significantly lower in external fixation group comparing to other groups (p = 0.014). Cox regression analysis showed the number of comorbidities 2 and ≥ 3 (p = 0.0027, p = 0.015), transfusion requirement (p = 0.0001), ASA 4 (p = 0.016) to be significant predictors of mortality.Conclusions
Transfusion requirement, ASA grade 4 and having more than two comorbidities are risk factors for mortality in geriatric hip fractures. Type of surgical intervention and fracture type had similar mortality rates in our patient population.6.
Mahfud Mahfud Stefan Breitenstein Ashraf Mohammad El-Badry Milo Puhan Andreas Rickenbacher Panagiotis Samaras Patrick Pessaux Santiago Lopez-Ben Daniel Jaeck Joan Figueras Pierre Alain-Clavien 《World journal of surgery》2010,34(1):92-100
Background
Chemotherapy may increase postoperative morbidity and mortality after liver surgery. Especially bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), could have a detrimental effect. To assess the impact of neoadjuvant bevacizumab on clinical outcome after hepatectomy for colorectal liver metastases (CRLMs) this case-matched control study was initiated.Methods
The multicentric data collection was performed in the Swiss HPB Center of the University Hospital Zurich (CH), the Department of Digestive Surgery and Transplantation Strasbourg (F), and the Division of Hepato-biliary-pancreatic surgery of “Josep Tureta” Hospital Girona (E). Consecutive patients operated onbetween July 2005 and December 2007 due to CRLMs who received neoadjuvant chemotherapy were assessed. Patients were divided in two groups: group A had neoadjuvant chemotherapy with bevacicumab, and group B had it without bevacizumab.Results
No differences in overall morbidity (56 vs. 40% in the bevacizumab and control groups, respectively, p = 0.23) or mortality could be documented. Similarly, the incidence of severe postoperative complications was not statistically different between the bevacizumab and control groups (31 and 18%, respectively, p = 0.31). Wound complications were comparable (11% in the bevacizumab group compared and 9% in the control group, p = 1.00). However, bevacizumab was associated with a significantly decreased incidence of postoperative hepatic insufficiency (7 vs. 20%, p = 0.03).Conclusions
No impact on the incidence or severity of complications by bevacizumab could be shown. Bevacizumab may even reduce the incidence of liver failure after liver surgery. 相似文献7.
The effect of renal function on surgical outcomes of intracapsular hip fractures with osteosynthesis
Liang-Tseng Kuo Su-Ju Lin Wei-Hsiu Hsu Kuo-Ti Peng Chun-Liang Lin Robert Wen-Wei Hsu 《Archives of orthopaedic and trauma surgery》2014,134(1):39-45
Background
Chronic kidney disease (CKD) affects many physiologic systems, including bone quality, nutrition, and cardiovascular condition. Femoral neck fractures in patients on dialysis are associated with frequent complications and a high risk of mortality. However, the effect of CKD on clinical outcomes of patients with hip fractures treated with osteosynthesis remains unclear.Methods
One hundred and thirty patients with 130 femoral neck fractures treated with internal fixation were divided into two groups and the data were then analyzed. Group 1 consisted of 98 patients (98 hip fractures) with normal renal function (estimated glomerular filtration rate, or eGFR, ≥60 ml/min/1.73 m2). Group 2 was composed of 32 patients (32 hip fractures) with CKD (eGFR <60 ml/min/1.73 m2) without dialysis. Clinical outcomes as well as early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were then compared.Results
In Group 1, 32 complications (32.6 %) occurred in 98 hips, including 5 cases of nonunion and 16 cases of osteonecrosis. In Group 2, 24 complications (75 %) developed in 32 hips; these included 8 cases of nonunion and 3 cases of osteonecrosis. The mean duration of follow-up was 32 months. The overall mortality rate was 11.5 %. No difference was noted in early, late, or overall mortality rate between two groups. Patient with CKD had a higher nonunion rate (OR = 5.9, P = 0.023). Meanwhile, CKD and displaced fracture pattern were independent predictors for revision surgery (OR = 3.0, P = 0.032; OR = 6.9, P = 0.001, respectively).Conclusions
Osteosynthesis is a safe and effective treatment for femoral neck fractures; however, patients with femoral neck fracture and CKD have a higher risk of nonunion and subsequent surgical revision.Level of relevance
Prognostic studies, Level III. 相似文献8.
Background
Up to 4 % of patients presenting with a hip fracture may be on warfarin at admission. There is little consensus on the timing, dosage or route of vitamin K administration. We aimed to evaluate the impact of a locally developed, evidence-based protocol for perioperative warfarin management on the admission-to-operation time (AOT) in hip fracture patients.Materials and methods
Clinical and demographic data were collected prospectively for hip fracture patients who were on warfarin at the time of admission (post-protocol group) and compared to a historical control group of patients who were on warfarin before implementation of the protocol (pre-protocol group). Univariate analysis was undertaken to identify any significant differences between the two groups.Results
Twenty-seven patients in the pre-protocol group (27/616, 4.4 %) and 40 patients in the post-protocol group (4.7 %, 40/855) were on warfarin at admission. There was a significant reduction in the median AOT from 73 h (IQR 46–105) to 37.7 h (IQR 28–45) after implementation of the warfarin protocol (p < 0.001). The proportion of patients operated on within 48 h of admission increased from 30 % (8/27) in the pre-protocol group to 80 % (32/40) in the post-protocol group (p < 0.001). No significant differences in hospital length of stay (p = 0.77) or the postoperative warfarin recommencement time (p = 0.90) were noted between the two groups.Conclusion
Implementation of a perioperative warfarin management protocol can expedite surgery in hip fracture patients, but did not reduce hospital stay in our cohort, possibly because of a delay in recommencing warfarin in these patients postoperatively.Level of evidence
Level III. 相似文献9.
10.
Background
The relationship between nutritional risk and postoperative recovery of patients with major laparoscopic abdominal surgery is still unclear. The present study was designed to assess the value of the nutritional risk screening in predicting the postoperative outcomes in this cohort of patients.Methods
Data from a consecutive series of 75 patients undergoing various elective major laparoscopic abdominal operations was prospectively collected. Nutritional risk was defined by the Nutritional Risk Screening 2002 (NRS 2002) score and correlated to the incidence of postoperative complications and hospital stay. Multivariate regression identified factors associated with 30-day complications [odds ratio (95 % confidence interval)].Results
The overall incidence of nutritional risk was 34.7 %. There was a significantly higher infectious complication rate of 38.5 % in patients at nutritional risk, compared to 12.2 % in patients at no risk (p = 0.008). No significant difference of postoperative hospital stay and overall complications was found in patients at nutritional risk or not. Nutritional risk was identified as an independent predictor of postoperative infectious complications (odds ratio 4.87 [1.33–17.84]; p = 0.017).Conclusions
The present study reinforces the value of the NRS 2002 to identify patients at higher risk of infectious complications after major laparoscopic abdominal surgery. In the era of minimally invasive surgery, the problem of nutritional risk still deserves our attention and concern. 相似文献11.
Background
Survival after pancreatic head adenocarcinoma surgery is determined by tumor characteristics, resection margins, and adjuvant chemotherapy. Few studies have analyzed the long-term impact of postoperative morbidity. The aim of the present study was to assess the impact of postoperative complications on long-term survival after pancreaticoduodenectomy for cancer.Methods
Of 294 consecutive pancreatectomies performed between January 2000 and July 2011, a total of 101 pancreatic head resections for pancreatic ductal adenocarcinoma were retrospectively analyzed. Postoperative complications were classified on a five-grade validated scale and were correlated with long-term survival. Grade IIIb to IVb complications were defined as severe.Results
Postoperative mortality and morbidity were 5 and 57 %, respectively. Severe postoperative complications occurred in 16 patients (16 %). Median overall survival was 1.4 years. Significant prognostic factors of survival were the N-stage of the tumor (median survival 3.4 years for N0 vs. 1.3 years for N1, p = 0.018) and R status of the resection (median survival 1.6 years for R0 vs. 1.2 years for R1, p = 0.038). Median survival after severe postoperative complications was decreased from 1.9 to 1.2 years (p = 0.06). Median survival for N0 or N1 tumor or after R0 resection was not influenced by the occurrence and severity of complications, but patients with a R1 resection and severe complications showed a worsened median survival of 0.6 vs. 2.0 years without severe complications (p = 0.0005).Conclusions
Postoperative severe morbidity per se had no impact on long-term survival except in patients with R1 tumor resection. These results suggest that severe complications after R1 resection predict poor outcome. 相似文献12.
Background
Previous research suggested that antireflux surgery reached its peak volume in the US more than a decade ago. Factors such as changes in population demographics and improvements in surgical outcomes may have reversed this decline. We sought to examine national trends in the management of antireflux surgery patients and identify patient and hospital characteristics associated with postoperative complications.Methods
We analyzed data from the Nationwide Inpatient Sample to identify adults with gastroesophageal reflux disease or esophagitis who underwent elective antireflux surgery between 2005 and 2010. Patient and hospital characteristics were analyzed. A multivariate logistic regression model was used to identify characteristics associated with an increased risk of postoperative complications following laparoscopic antireflux surgery.Results
The volume of elective antireflux surgery remained relatively stable between 2005 (n = 15,819) and 2010 (n = 18,780). The percentage of patients older than 64 years of age increased from 21.1 % in 2005 to 30.9 % in 2010 (p < 0.01), while the percentage with a Charlson score over 2 more than doubled (1.2–2.7 %; p < 0.01). Inpatient complication rates (6.3 vs. 6.6 %; p = 0.21) and mortality (0.08 vs. 0.21; p = 0.72) were unchanged. On multivariate analysis, patients older than 79 years were three times as likely to develop a complication (odds ratio [OR] 3.1; 95 % CI 2.1–4.5) as were patients with a Charlson score over 2 (OR 3.1; 95 % CI 2.2–4.3).Conclusions
Today’s antireflux surgery patient population is a higher-risk cohort, but complication rates have remained stable and inpatient mortality has declined more than 50 % over the past decade. Given these findings, additional research is needed to understand why antireflux surgery is underutilized, with a decline of more than two-thirds since its peak in 1999. 相似文献13.
Anthony W. Castleberry MD MMCi Bryan M. Clary MD John Migaly MD Mathias Worni MD MHS Jeffrey M. Ferranti MD MS Theodore N. Pappas MD John E. Scarborough MD 《Annals of surgical oncology》2013,20(12):3715-3724
Background
Complex, oncologic surgery is an important component of resident education. Our objective was to evaluate the impact of resident participation in oncologic procedures on overall 30-day morbidity and mortality.Methods
A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005–2009. Colorectal, hepatopancreaticobiliary, and gastroesophageal oncology procedures were included. Multivariate logistic regression was used to assess the impact of trainee involvement on 30-day morbidity and mortality after adjusting for potential confounders.Results
A total of 77,862 patients were included for analysis, 53,885 (69.2 %) involving surgical trainees and 23,977 (30.8 %) without trainees. The overall 30-day morbidity was significantly higher in the trainee group [27.2 vs. 21 %, adjusted odds ratio (AOR) 1.19, 95 % confidence interval (CI) 1.15–1.24, p < 0.0001)]; however, there was significantly lower 30-day postoperative mortality in the trainee group (1.9 vs. 2.1 %, AOR 0.87, 95 % CI 0.77–0.98, p = 0.02) and significantly lower failure-to-rescue rate (defined as mortality rate among patients suffering one or more postoperative complications) (5.9 vs. 7.6 %, AOR 0.79, 95 % CI 0.68–0.90, p = 0.001). The overall 30-day morbidity was highest in the PGY 5 level (29 %) compared to 24 % for PGY 1 or 2 and 23 % for PGY 3 (AOR per level increase 1.05, 95 % CI 1.03–1.07, p < 0.0001).Conclusions
Trainee participation in complex, oncologic surgery is associated with significantly higher rates of 30-day postoperative complications in NSQIP-participating hospitals; however, this effect is countered by overall lower 30-day mortality and improved rescue rate in preventing death among patients suffering complications. 相似文献14.
N. D. Clement K. Green N. Murray A. D. Duckworth M. M. McQueen C. M. Court-Brown 《Journal of orthopaedic science》2013,18(4):578-585
Background
Reported revision of internal fixation for undisplaced intracapsular hip fractures is between 12 and 17 % at 1 year. This risk is greater for elderly patients, for whom mortality after such a fracture is also higher. Our purpose was to identify predictors of fixation failure and mortality for elderly patients sustaining undisplaced intracapsular hip fractures, and to assess whether their socioeconomic status affected their outcome.Methods
During a 3-year period we prospectively compiled a consecutive series of 162 elderly (≥65 years old) patients who underwent internal fixation for an undisplaced (Garden stage I or II) intracapsular hip fracture. Patient demographics, American Society of Anesthesiologists (ASA) grade, and posterior tilt (measured on the lateral radiograph) were recorded pre-operatively. All patients were followed up for a minimum of 1 year. Each patient’s socioeconomic status was assigned by use of the Scottish Index of Multiple Deprivation. Patient mortality was established by use of the General Register Office for Scotland.Results
There were 28 failures of fixation during the study period. In Cox regression analysis, ASA grade and the presence of posterior tilt (p < 0.0001) were significant independent predictors of fixation failure. Overall unadjusted mortality at 1 year was 19 % (n = 30/162). Cox regression analysis also affirmed ASA grade to be the only significant independent predictor of 1-year mortality (p = 0.003). The standardised mortality rate for the cohort was 2.3 (p < 0.001), and was significantly greater for patients less than 80 years of age (p = 0.004). Socioeconomic status did not affect outcome, but the most deprived patients sustain their fracture at a significantly younger age (p = 0.001).Conclusion
We have demonstrated that ASA grade and posterior tilt of the femoral neck are independent predictors of fixation failure of undisplaced intracapsular hip fractures in elderly patients, and ASA grade was also an independent predictor of mortality. 相似文献15.
Alessandro De Cesare Barbara Cangemi Enrico Fiori Marco Bononi Roberto Cangemi Luigi Basso 《Surgery today》2014,44(8):1424-1433
Purpose
To evaluate the early and long-term postoperative results of malabsorptive surgery in morbidly obese patients.Methods
Between 2000 and 2007, 102 morbidly obese patients were referred to the Department of Surgery “Pietro Valdoni”, “Sapienza” University of Rome, Policlinico “Umberto I°”, Rome, Italy for malabsorptive surgery. All patients underwent derivative biliodigestive surgery after they had been reviewed by a team of surgeons, physicians, dieticians, and psychologists.Results
There were no intra-operative complications, but two patients suffered postoperative pulmonary embolisms, which resolved with medical treatment. The mean postoperative hospital stay was 7 days, with no early or late mortality. Maximum weight loss was reached 12–24 months after surgery, while the mean percentage excess weight loss at 3–5 years ranged from 45 to 64 %. Specific postoperative complications in the first 2 years after surgery were abdominal abscess (n = 2), gastroduodenal reflux (n = 4), and incisional hernia (n = 6). Diabetes resolved in 98 % of the diabetic patients within a few weeks after surgery and blood pressure normalised in 86.4 % of those who had had hypertension preoperatively. Obstructive sleep apnoea and obesity hypoventilation syndrome also improved significantly in 92 % of the patients.Conclusions
Morbidly obese patients can undergo biliodigestive surgery safely with good long-term weight loss and quality of life expectancy. 相似文献16.
Purpose
Obturator hernia is a rare disease and preoperative diagnosis is always difficult. There are increasing reports employing laparoscopic approach in the recent literature. Our aim was to review and compare the open and laparoscopic approach in repairing obturator hernia.Methods
All patients with obturator hernia from 1997 to 2011 were recruited. Patient’s demographics, presentation, operative details, morbidity, and mortality were retrospectively collected and reviewed.Results
There were 36 patients during the 15-year period. All of them were elderly ladies (median 83). Nineteen underwent open surgery while 16 received laparoscopic surgery. Both age and ASA were comparable. The median operative time was 68 and 65 min for laparoscopic and open group, respectively (p = 0.690). The median hospital stay was significantly longer in the open group (19 vs 5 days, p = 0.007). There were less major complications (p = 0.004) and mortality (p = 0.049) in the laparoscopic group. Two recurrences were reported in the laparoscopic group, although statistically not significant (p = 0.202).Conclusions
Laparoscopic repair can achieve a shorter hospital stay and has lesser major complications and mortality in selected patients. 相似文献17.
Raymond Oliphant MBChB Gary A. Nicholson MD Paul G. Horgan PhD Richard G. Molloy MD Donald C. McMillan PhD David S. Morrison MD 《Annals of surgical oncology》2013,20(7):2132-2139
Background
Deprivation is associated with poorer survival after surgery for colorectal cancer, but determinants of this socioeconomic inequality are poorly understood.Methods
A total of 4,296 patients undergoing surgery for colorectal cancer in 16 hospitals in the West of Scotland between 2001 and 2004 were identified from a prospectively maintained regional audit database. Postoperative mortality (<30 days) and 5-year relative survival by socioeconomic circumstances, measured by the area-based Scottish Index of Multiple Deprivation 2006, were examined.Results
There was no difference in age, gender, or tumor characteristics between socioeconomic groups. Compared with the most affluent group, patients from the most deprived group were more likely to present as an emergency (23.5 vs 19.5 %; p = .033), undergo palliative surgery (20.0 vs 14.5 %; p < .001), have higher levels of comorbidity (p = .03), have <12 lymph nodes examined (56.7 vs 53.1 %; p = .016) but were more likely to receive surgery under the care of a specialist surgeon (76.3 vs 72.0 %; p = .001). In multivariate analysis, deprivation was independently associated with increased postoperative mortality [adjusted odds ratio 2.26 (95 % CI, 1.45–3.53; p < .001)], and poorer 5-year relative survival [adjusted relative excess risk (RER) 1.25 (95 % CI, 1.03–1.51; p = .024)] but not after exclusion of postoperative deaths [adjusted RER 1.08 (95 %, CI .87–1.34; p = .472)].Conclusions
The observed socioeconomic gradient in long-term survival after surgery for colorectal cancer was due to higher early postoperative mortality among more deprived groups. 相似文献18.
Ning Li Weiming Zhu Yi Li Jianfeng Gong Lili Gu Min Li Lei Cao Jieshou Li 《World journal of surgery》2014,38(7):1860-1867
Background
The abdominal cocoon (AC) is a condition in which a variable length of healthy small bowel is enveloped in a fibrocollagenous membrane, giving the appearance of a cocoon. Early experiences with treatment were associated with high mortality and morbidity rates and a low preoperative diagnostic rate, leading to underestimation of the treatment benefit of surgery.Methods
We retrospectively reviewed the medical records of 65 patients who were diagnosed as having AC from 2001 to 2011. The clinical data, surgical intervention, and perioperative management were carefully reviewed.Results
The 65 patients (57 male, 8 female) had a median age of 39 years (range 14–79 years). Patients who received preoperative nutritional support had higher rate of grade 0 complications (p = 0.012) and a lower rate of grade II complications (p = 0.012) than those without nutritional support. Intestinal stenting during surgical intervention also decreased both grade I (p = 0.012) and grade II (p = 0.007) complications. Patients who received preoperative nutritional support and underwent intestinal stenting had a lower rate of postoperative complications (p < 0.05). In addition, patients with preoperative nutritional support were more satisfied postoperatively (p = 0.018) than those without nutritional support. This was also observed in patients with intestinal stenting versus those without it (p = 0.027).Conclusions
Our single-center study with a large number of patients provided evidence regarding the epidemiology of AC. Preoperative nutritional support and intestinal stenting significantly reduced postoperative complications and, more importantly, increased postoperative satisfaction. 相似文献19.
Roberto F. Klappenbach Federico J. Yazyi Facundo Alonso Quintas Matías E. Horna Juan Alvarez Rodríguez Alejandro Oría 《World journal of surgery》2013,37(10):2293-2299
Background
Early oral feeding (EOF) has been demonstrated to be safe and beneficial after abdominal elective surgery. The aim of this randomized controlled trial is to assess the safety and benefits of EOF compared to traditional postoperative care (TPC) after abdominal emergency surgery.Methods
Patients assigned to the EOF group commenced a soft diet within 24 h after surgery. In the TPC group, a liquid diet was commenced upon passage of flatus or stool and then advanced to soft food. The primary endpoint was the complication rate. Secondary endpoints were severity of complications, mortality, gastrointestinal leaks, surgical-site infection, reoperation, diet intolerance, time to first flatus and stool, amount of food intake, postoperative discomfort, hospital stay, weight loss at the 15th postoperative day and incisional hernias.Results
A total of 295 patients assigned to EOF (n = 148) or TPC (n = 147) were analyzed. No significant differences were seen in the complications rates (EOF 45.3 % vs. TPC 37.4 %; p = 0.1). There was a significantly higher rate of vomiting with EOF (EOF 13.5 % vs. TPC 6.1 %; p = 0.03), with no differences in nasogastric tube reinsertion. EOF patients’ food intake was proportionally lower for the first three meals than that of TPC patients (p < 0.01). Postoperative discomfort survey revealed more hunger in the TPC group (p < 0.01). There were no differences in postoperative ileus or length of hospital stay.Conclusions
EOF was safe after abdominal emergency surgery. EOF was associated with more vomiting (treated easily and without patient discomfort) and less hunger than with TPC. No other EOF-related benefits could be demonstrated during this trial. 相似文献20.
Laurent Sulpice Michel Rayar Boris Campillo Claire Pery Antoine Guillaud Bernard Meunier Karim Boudjema 《World journal of surgery》2014,38(4):918-926