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1.
《Journal of the American College of Surgeons》2014,218(6):1105-1112
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Beau J. Kildow Elizabeth P. Howell Vasili Karas William T. Baumgartner Daniel J. Cunningham Cynthia L. Green Michael P. Bolognesi Thorsten M. Seyler 《The Journal of arthroplasty》2018,33(10):3211-3214
Background
Routine laboratory studies are often obtained following total hip arthroplasty (THA). Moreover, laboratory studies are often continued daily until the patient is discharged regardless of medical management. The purpose of this study was to investigate the use of routine complete blood count (CBC) tests following THA. Secondarily, the purpose was to identify patient factors associated with abnormal postoperative lab values.Methods
This retrospective review identified 352 patients who underwent primary THA at a single institution from 2012 to 2014. Preoperative and postoperative CBC values were collected along with demographic data, use of tranexamic acid (TXA), and transfusion rates. Logistic regression models were used to identify factors associated with an abnormal postoperative lab and risk of transfusion.Results
Of the 352 patients, 54 patients were transfused (15.3%). Patients who underwent transfusion had a significantly lower preoperative hemoglobin (Hb; 12.0 g/dL) compared to patients who did not undergo transfusion (13.5 g/dL; P < .001). Patients who did not receive TXA were 3.7 times more likely to receive a transfusion. No patients received medical intervention based on the outcome of postoperative platelet or white blood counts. A Hb value below 11.94 g/dL for patients who are anemic preoperative or did not receive TXA predicted transfusion after postoperative day 1.Conclusion
Under value-based care models, cost containment while maintaining high-quality patient care is critical. Routine postoperative CBC tests in patients with a normal preoperative Hb who receive TXA do not contribute to actionable information. Patients who are anemic before THA or do not receive TXA should at minimum obtain a CBC on postoperative day 1. 相似文献3.
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Follow-up examinations are advised 1, 3, 6, 12, 18, and 24 months and yearly thereafter by the European Collaborating Group
on Stent-Graft Techniques for Abdominal Aortic Aneurysm Repair (EUROSTAR). The aim of this study was to evaluate the determinants
and consequences of surveillance completeness. Patients who underwent endovascular abdominal aortic aneurysm repair between
October 1996 and August 2004 and enrolled in the EUROSTAR registry were analyzed. Two groups were compared: patients who attended
all scheduled visits (group A) and those who came infrequently (group B). Odds ratios and hazard rates (HRs) with 95% confidence
intervals (CIs) were determined to detect which patient characteristics and complications were associated with follow-up intensity.
Of the 4,433 patients, 1,538 (35%) attended all scheduled visits until the end of follow-up (group A). Analysis of patient
characteristics demonstrated that intensive visitors were more often smokers, hyperlipemic, and considered unfit for open
surgery or general anesthesia. Complications during follow-up, including endoleaks (24% vs. 20%), kinking (3.5% vs. 2.5%),
and migration (4.9% vs. 3.5%), appeared significantly more frequently in group A. Despite intensive follow-up of this category,
still a greater proportion died (12% vs. 9%, adjusted HR = 1.5, 95% CI 1.2-1.8). After 84 months of follow-up, the cumulative
survival rates in groups A and B were 71% and 74%, respectively (p < 0.0001). It seems that follow-up intensity was based on baseline patient characteristics. High-risk patients had, despite
more intensive surveillance, still more complications after adjustment for patient, morphological, and center-specific characteristics.
Further assessment is indicated to evaluate the effectiveness of different frequencies of surveillance visits. 相似文献
6.
Incisional hernias and other ventral hernias are common surgical problems. It is estimated that incisional hernia complicates about 2 % to 10 % of laparotomies. Ventral and incisional hernia repairs are among the common surgeries done by a general surgeon. It is proven beyond any doubt that suture repair of these hernias should not be done as recurrence rates are unacceptably high, some series reporting as high as 54 % on long-term follow-up. A prosthetic mesh should always be used in ventral hernia repair (VHR). Now, the polypropylene mesh (PPM) has become the prosthetic mesh of choice in the repair of hernias, including inguinal hernia. However, with the advent of laparoscopic repair where the mesh is placed intraperitoneally, concerns regarding safety of PPM are raised. Newer meshes are introduced, claiming lesser complication rate. Many types of newer meshes are available now. Newer meshes are invariably costlier than PPM by 15–20 times. Is this extra cost worth? We looked in to available literature for an answer. 相似文献
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P.G. Kalman 《Acta chirurgica Belgica》2013,113(2):197-202
Purpose : To determine the longterm results of conventional open surgical repair of abdominal aortic aneurysms (AAAs) and the prevalence of late arterial abnormalities.Methods : CT scan follow-up was obtained between 8 and 9 years after elective AAA repair on a cohort of patients enrolled in the Canadian Aneurysm Study, a registry that originally consisted of 680 patients. A request for CT follow- up was sent to the responsible surgeon in 1994 when 251 patients were alive and available. Ninety-four of the 251 patients agreed to undergo an abdominal and thoracic CT scan, and each scan was interpreted independently by two vascular radiologists.Results : The aorta was analysed in five defined segments, and an aneurysm was defined as > 50% enlargement from the expected normal value as defined in the Reporting Standards for Aneurysms. Using this strict definition, 64.9% of patients had an aneurysm, but the abnormality was considered a possible indication for surgical repair in 13.8%. Of the 39 patients who had an initial repair with a tube graft, 12 (30.8%) were found to have an iliac aneurysm and 6 (15.4%) were considered to be of possible surgical significance. The median graft size at the time of operation was 18 mm, which increased to a median size of 22 mm at follow-up. Fluid or thrombus around the graft was observed in 28%, and bowel was intimately associated with the graft in 7%.Conclusions : The longterm results of conventional open surgical repair is durable. CT scan follow-up between 8 and 9 years postoperatively often demonstrates aortic and iliac abnormalities, but the majority are not clinically significant. On the basis of these findings, a routine CT scan of the abdomen and chest is recommended after 5 years. This study provides a population based study for comparison with the longterm results of endovascular repair. 相似文献
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INTRODUCTION: Complete repair of classic bladder exstrophy in male newborns has been successful with minimal morbidity. However, the technique may create hypospadias in some cases. We have recently adopted a modification to obtain an orthotopic meatus in bladder exstrophy boys. MATERIALS AND METHODS: Between November 1998 and December 2002 complete repair of classic bladder exstrophy was carried out in 27 boys. Complete penile disassembly was performed in 22 boys including 4 newborns and 18 older children; mean age 3+/-2 years old. Modified disassembly was used in the last 5 boys including 4 newborns and a 9-month-old boy. During repair of epispadias, the dissection starts on the ventral aspect of the penis as usual. The urethral plate is separated from both corpora cavernosa to allow ventral transposition of the plate. In the complete disassembly technique, the urethral plate is completely separated from both hemiglans. In this modification, while the urethral plate is completely separated from both corpora cavernosa, the extreme distal end of the urethral plate remains attached to the distal ends of both hemiglans. Thus, when the plate is tubularized with fine interrupted sutures the meatus ends up at the tip of the glans penis. The symphysis pubis is re-approximated as usual and corpora cavernosa are approximated dorsally in the midline. RESULTS: There was no major complication. Mean follow-up was 43+/-7 and 7+/-4 months for complete and modified disassembly groups respectively. Of the 22 boys, who underwent complete disassembly, 15 (68%) ended up with hypospadias and 7 (32%) had an orthotopic meatus. Modified disassembly has resulted in an excellent cosmetic appearance and orthotopic meatus in the 5 boys. Penile length was not shorter than boys who underwent complete disassembly. Parents of the 5 boys noticed normal straight morning erection. CONCLUSION: Although complete penile disassembly allows ventral placement of the urethra, hypospadias is created in approximately two thirds of the cases. When the extreme distal end of the urethral plate remains attached to the distal ends of both hemiglans (modified disassembly), orthotopic meatus can be obtained in all boys. With modified disassembly, posterior mobilization of the bladder and urethra does not result in corporal angulations or shortening because of the proportionate inward movement of the corpora that accompanies symphyseal approximation. The modification is feasible in newborns and infants. These short-term results may obviate the need for later penile reconstructive procedure. 相似文献
9.
E. Altinli K. Saribeyoglu T. Karahasanoglu I. Hamzaoglu F. Aydogan I. Karabiçak 《Acta chirurgica Belgica》2013,113(4):410-412
Purpose : The objective of this study was to assess the effecacy of clip application in the surgical repair of iatrogenic colonic perforations.Material andMethods : Twenty adult male Wistar-Albino rats were divided into two equal groups of ten. In both of the groups an iatrogenic perforation was made in the anti-mesenteric border of the left colon. The defect was closed with interrupted 6/0 polypropylene sutures in group 1 and extraluminal application of vascular clips (VCS-vascular clip system) in group 2. All animals were killed on postoperative Day 4. Wound healing was evaluated with both in situ bursting pressure and hydroxyproline levels.Results : There was no statistically significant difference between the two groups in respect of bursting pressure levels (p = 0.063) whereas hydroxyproline levels were higher in group 2 (p = 0.0021).Conclusions : Surgical repair of iatrogenic colonic perforations by extraluminal clips gives comparable results according to wound healing parameters. This approach may be a rational alternative to suture or endoscopic repair methods. 相似文献
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Coulston JE Williams GL Stephenson BM 《Annals of the Royal College of Surgeons of England》2008,90(2):140-141
INTRODUCTION
The objective of this study was to examine referral patterns from general practitioners for groin hernia surgery and to assess their knowledge of services available to their patients.PATIENTS AND METHODS
An anonymous postal questionnaire was sent to 120 general practitioners (GPs) in the South East Wales region who routinely refer patients for inguinal hernia surgery to the Royal Gwent Healthcare NHS Trust.RESULTS
A total of 86 questionnaire replies were returned. There was variation in referral patterns between the GPs with the majority (84%) referring their patients for groin hernia repair to either a general surgeon or as an open referral. Only 14% referred directly to a hernia specialist and none regularly referred to a laparoscopic surgeon.CONCLUSIONS
Referral patterns for inguinal hernia surgery do not reflect services provided in secondary care. Further education is required so that a patient''s care can be optimised. 相似文献12.
Baril DT Carroccio A Ellozy SH Palchik E Addis MD Jacobs TS Teodorescu V Marin ML 《Annals of vascular surgery》2006,20(2):188-194
Spinal cord ischemia after endovascular thoracic aortic repair remains a significant risk. Previous or concomitant abdominal aortic repair may increase this risk. This investigation reviews the occurrence of spinal cord ischemia after endovascular repair of the descending thoracic aorta in patients with previous or concomitant abdominal aortic repair. Over an 8-year period, 125 patients underwent endovascular exclusion of the thoracic aorta at the Mount Sinai Medical Center. Twenty-eight of these patients had previous or concomitant abdominal aortic repair. The 27 patients who underwent staged repairs all had cerebrospinal fluid (CSF) drainage during and following repair. This population was analyzed for the complication of spinal cord ischemia and factors related to its occurrence. Mean follow-up was 19.3 months (range 1-61). Spinal cord ischemia developed in four of the 28 patients (14.3%) who underwent endovascular thoracic aortic repair with previous or concomitant abdominal aortic repair, while one of 97 patients (1.0%) developed ischemia among the remaining thoracic endograft population. One patient with concomitant abdominal aortic repair developed cord ischemia that manifested 12 hr following the procedure. The remaining three patients with previous abdominal aortic repair developed more delayed-onset paralysis ranging from the third postoperative day to 7 weeks following repair. Irreversible cord ischemia occurred in three patients, with full recovery in one patient. Major complications from CSF drainage occurred in one patient (3.7%). Spinal cord ischemia occurred at a markedly higher rate in patients with previous or concomitant abdominal aortic repair. This risk continued beyond the immediate postoperative period. The benefit of perioperative and salvage CSF drainage remains to be determined. 相似文献
13.
Ghavidel AA Javadpour H Tabatabaei MB Adambeig A Raeisi K Noohi F 《Journal of cardiac surgery》2008,23(1):23-26
A minority of patients with Tetralogy of Fallot (TF) survive into adulthood. These patients have been subjected to a prolong period of cyanosis and hypoxia. The aim of this study is to assess the benefits of total correction of TF in this adult population. From August 1995 to March 2005, fifty one patients underwent total correction of TF. The mean age was 22.2 years (range 16 to 38 years). There were 31 males and 20 females. Twenty two percent of patients were in NYHA functional class III prior to the operation. The mean gradient across the right ventricular outflow tract was 81.7 mmHg (range 30 to 130 mmHg). The operation was performed through the right ventricle in the majority of patients. Transannular patch was used in 33 patients. The mean follow-up period was 42 months ranging from 1 to 116 months. Hospital mortality was 1.9% (1 patient), and one patient died three months after the operation. Post-operatively 87.3% of patients were in NYHA functional class I. During the follow-up period four patients required re-operation; two for residual ventricular septal defect, one for residual pulmonary stenosis and one had pulmonary valve replacement for severe pulmonary regurgitation. Complete repair of TF in adults is feasible with acceptable mortality and morbidity. The main benefit of the operation is functional improvement in this patient population. 相似文献
14.
Background
In the new international guidelines only the mesh-based Lichtenstein, TEP and TAPP techniques are recommended. This present analysis of data from the Herniamed Registry compares the outcome for Shouldice versus Lichtenstein, TEP and TAPP.Methods
Propensity score matching analyses were performed to obtain homogeneous comparison groups for Shouldice versus Lichtenstein (n = 2115/2608; 81.1%), Shouldice versus TEP (n = 2225/2608; 85.3%) and Shouldice versus TAPP (2400/2608; 92.0%).Results
The most important characteristics of the Shouldice patient collective were younger patients with a mean age of 40 years, a large proportion of women of 30%, a mean BMI value of 24 and a proportion of defect sizes up to 3 cm of over 85%. For this selected patient collective, propensity score matched-pair analysis did not identify any difference in the perioperative and one-year follow-up outcome compared with TAPP, fewer intraoperative (0.5 vs. 1.3%; p = 0.009) but somewhat more postoperative complications (2.3 vs. 1.5%; p = 0.050) compared with TEP and advantages with regard to pain at rest (4.6 vs. 6.1%; p = 0.039) and on exertion (10.0 vs. 13.4%; p < 0.001) compared with the Lichtenstein technique.Conclusion
For a selected group of patients the Shouldice technique can be used for primary unilateral inguinal hernia repair while achieving an outcome comparable to that of Lichtenstein, TEP and TAPP operations.15.
Background Successful obesity surgery often results months later in redundant abdominal skin and subcutaneous tissue. Following open
obesity surgery, ventral hernias are also common, yet little has been written about the safety of combining panniculectomy
with ventral hernia repair. We performed a retrospective analysis of a single plastic surgeon’s experience with panniculectomy
following gastric bypass surgery including both patients undergoing and those not undergoing simultaneous ventral hernia repair.
Methods We reviewed the hospital and office records of patients undergoing panniculectomy at two university-affiliated community hospitals
from March 2002 to February 2005 following gastric bypass surgery.
Results The records of 100 patients (91 women) were available for review. Median age was 48 (range 25–65) and median interval between
bypass surgery and panniculectomy was 23 months (range 6–286). Median decrease in BMI was 19 (range 13–47). Eighty-three patients
underwent panniculectomy combined with at least one other procedure, most commonly ventral hernia repair (70) and buttock
lift (9). Forty hernia repairs were performed with mesh. No patient required mesh removal in the postoperative period. Median
length of hospital stay was 3 days (range 1–7). Twenty-nine patients required outpatient sharp debridement. Ten patients were
readmitted for management of wound complications. No patients sustained a stroke, myocardial infarction, or pulmonary embolus.
There was no mortality.
Conclusions Following obesity surgery, simultaneous ventral hernia repair and panniculectomy can be accomplished safely with short hospital
stays and few in-hospital complications. Postoperative wound problems are not infrequent but can be managed in the outpatient
setting. 相似文献
16.
This study was undertaken to assess the degree of ubiquity of umbilical hernias (UHs) in Nigerians and to determine if a
laissez faire approach to the presence of UHs is justified. A prospective evaluation was conducted of the umbilical area of
4052 Nigerians living in the vicinity of the Baptist Medical Centre (BMCO) in Ogbomoso, Nigeria. The diameter of the fascial
defect was measured with the subject supine and the protrusion of the umbilical skin with the subject erect. Subjects were
divided into three groups: group 1 (1 month to 18 years old); group 2 (older than 18 years); and group 3 (pregnant women in
an antenatal clinic). “Outies” (defined as any protrusion of the umbilical tip past the periumbilical skin) were present in
92% of group 1, 49% of group 2, and 90% of group 3 subjects. UHs (defined as protrusion of at least 5 mm and diameter of at
least 10 mm) were present in 23% of group 1, 8% of group 2, and 15% of group 3 subjects. Spontaneous closure of UHs seems
to occur until age 14. A retrospective analysis identified 11 patients undergoing emergency operations for UH-related problems
during the past 15 years. With a low incidence and 0% mortality rate associated with management of these emergencies, a policy
of prophylactic repair is not justified at BMCO. Because most of the children we examined had outies, repair for cosmetic
reasons is rarely requested. The only logical indication for repair of UHs at BMCO is incarceration, and this rarely occurs. 相似文献
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J T Powell A R Brady S G Thompson F G Fowkes R M Greenhalgh 《European journal of vascular and endovascular surgery》2001,21(1):65-69
BACKGROUND AND PURPOSE: the ankle/brachial pressure index (ABPI) has been shown to be a reliable marker of cardiovascular risk in population studies. We investigated whether the ABPI was a useful prognostic index for patients with abdominal aortic aneurysm. METHODS: patients entered into the U.K. Small Aneurysm Trial and Study had their ABPI measured in both legs at baseline (mean ABPI reported) and were followed up until 30 June 1998, with information about cause of death being obtained from the Office of National Statistics. This study focussed on cardiovascular and all-cause mortality. RESULTS: a total of 1827 men and 478 women, mean age 69 years, median aneurysm diameter 4.4 cm, were followed up for a median of 5.7 years. A total of 829 deaths were reported (rate 8.1 per 100 person-years), 546 (66%) from cardiovascular causes. The all-cause mortality risk increased as the ABPI decreased, hazard ratio 1.25 per 0.2 unit decrease in ABPI (95% CI 1.17 to 1.34, p<0.001). For patients in the lowest tertile group (ABPI <0.87) there were 11.6 deaths per 100 person-years. This increased risk persisted after adjustment for age, sex, evidence of ischaemia on resting ECG and initial aneurysm diameter, adjusted hazard ratio 1.17 per 0.2 unit decrease in ABPI (95% CI 1.07 to 1.28, p<0.001). CONCLUSION: the ankle/brachial pressure index is an important prognostic indicator for patients with abdominal aortic aneurysm. Patients with an ABPI below 0.87 (limit of lowest tertile) have the highest mortality risk and best clinical practice demands that attention is focussed on active treatment to minimise their cardiovascular risk factors. 相似文献
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Biancari F Mazziotti MA Paone R Laukontaus S Venermo M Lepäntalo M 《World journal of surgery》2011,35(7):1662-1670
Background
The role of open repair in the management of ruptured abdominal aortic aneurysm (RAAA) in patients >80 years old is questioned by the perceived high operative risk of these patients. This issue has been investigated in the present meta-analysis of observational studies. 相似文献19.
R. J. Hinchliffe S. W. Yusuf J. A. Macierewicz S. T. R. MacSweeney P. W. Wenham B. R. Hopkinson 《European journal of vascular and endovascular surgery》2001,22(6):528
Introduction: the mortality from ruptured abdominal aortic aneurysm (AAA) remains in the region of 50% despite advances in critical care. Endovascular repair of AAA has been shown to be associated with reduced physiological stress in the elective setting. It is hypothesised that the reduced physiological stress associated with EVAR may improve the outcome in patients with ruptured AAA. Methods: a feasibility study of endovascular repair of ruptured AAA was undertaken at the University Hospital, Nottingham, U.K. between 1994 and 2000. Patients admitted with ruptured AAA were assessed by a team familiar with endovascular techniques for elective repair of AAA. After giving informed consent patients underwent spiral computed tomographic angiography (CTA) in the majority of cases. Patients were then transferred to the operating theatre for EVAR. Results: twenty patients underwent repair of ruptured AAA. Of these 20 patients, seven were referred from another hospital. Eight patients were considered unfit for open repair. The median duration of procedure was 180 min (range 120–480) and median blood loss was 1200 ml (range 750–2000 ml). The overall peri-operative mortality was 45%. A number of intra-operative and peri-operative procedures (both open and endovascular) were required to ensure aneurysm exclusion and to deal with the complications of endovascular surgery. Conclusions: ruptured AAA remains a particularly hazardous condition to treat. There are a number of advantages of EVAR in this condition. A number of the problems early in the experience of EVAR have been addressed, but further experience is required to demonstrate its efficacy when compared with open repair. 相似文献
20.
Peter M. Thomson Jack Ross Samrat Mukherjee Borzoueh Mohammadi 《World journal of surgery》2016,40(6):1295-1298