共查询到20条相似文献,搜索用时 46 毫秒
1.
2.
Marinus D.J. Stowers James Aoina Andrew Vane Vaughan Poutawera Andrew G. Hill Jacob T. Munro 《The Journal of arthroplasty》2017,32(11):3379-3384
Background
Postoperative anemia following elective arthroplasty can lead to prolonged hospital stay and delays in rehabilitation and is often poorly tolerated in patients with cardiovascular disease. Tranexamic acid (TXA) has been shown to reduce perioperative blood loss in total knee arthroplasty (TKA). However, questions over its optimal route of administration remain.Methods
A double-blinded, placebo, multicentered, randomized, controlled trial investigating the efficacy of topical and systemic routes of a single intraoperative dose (1.5 g) of TXA was conducted. Patients undergoing primary, unilateral TKA were screened for eligibility. Eligible patients were consecutively enrolled from 5 New Zealand centers between July 2014 and November 2015. Three prospective groups running in parallel (topical TXA [tTXA], systemic TXA [sTXA], and placebo) were investigated for a primary outcome of estimated perioperative blood loss. An intention-to-treat analysis was used to compare outcomes between the study groups (P value <.05).Results
One hundred and thirty-four patients across the 5 hospitals were recruited into the study. Estimated blood loss was equivalent in the 2 treatment groups, sTXA (749 mL [95% confidence interval, 637-860]) and tTXA (723 mL [620-826]). Compared to the placebo group (1090 mL [923-1257]), blood loss was significantly lower in both treatment groups (P = .001 and P = .0003, respectively). There were no significant differences in secondary outcomes, including rates of symptomatic deep vein thrombosis and pulmonary embolism (P = .759).Conclusion
In the setting of elective TKA, a single 1.5-g dose of tTXA given intraoperatively either systemically or topically effectively reduces blood loss without an increase in complications. 相似文献3.
4.
5.
6.
7.
8.
9.
Bariatric surgery is the best long term treatment for morbid obesity. However, it carries risks of considerable morbidity and potential mortality. There is no published review on pre-operative identification of high-risk patients in bariatric surgery. This systematic review analyses obesity surgery mortality risk score (OS-MRS) as a tool for pre-operative prediction of mortality risk in bariatric surgery. Medline and Embase was systematically searched using the medical subjects headings (MeSH) terms 'bariatric surgery' and 'mortality' with further free text search and cross references. Studies that described OS-MRS to predict mortality risk after bariatric surgery were included in this review. Six studies evaluated 9,382 patients to assess the validity of OS-MRS to predict the mortality risk after bariatric surgery. Patient's age ranged from 19 to 67 years, and the body mass index ranged from 30 to 84. There were 83 deaths among the 9,382 patients (0.88 %) with individual studies reporting a mortality range from 0 % to 1.49 %. There were 13 deaths among 4,912 (0.26 %) class A patients, 55 deaths among 4,124 (1.33 %) class B patients and 15 deaths among 346 (4.34 %) class C patients. Mortality in classes A, B and C was significantly different from each of the other two classes (P < 0.05, χ(2)). This systematic review confirms that OS-MRS stratifies the mortality risk in the three-risk classification subgroups of patients. The OS-MRS can be used for pre-operative identification of high-risk patients undergoing primary Roux-en-Y gastric bypass surgery. 相似文献
10.
Background CRC (CRC) rates are low but increasing in Africa. Data on detection, treatment, and outcome are scarce.
Objective The aim of this study was to evaluate the presentation, treatment, and outcome pattern of CRC and to compare the care processes
for two time periods.
Setting The setting was Kenyatta National Hospital (KNH), a teaching and referral center.
Patients and methods A total of 259 patients seen over two time periods (1993–1998 and 1999–2005) were analyzed for admission date, sex, subsite
involvement, diagnostic process, treatment, follow-up, and outcome. The distribution of variables between the time periods
were analyzed using Student’s t-test and χ2 as appropriate. Survival trends were generated using Kaplan Meier method; p < 0.05 was statistically significant.
Results The average number of CRC diagnoses showed a 2.7-fold increase during the study periods. The mean age at presentation was
49.7 years. The mean duration of symptoms was 29.6 weeks; and the commonest subsite was the rectum (55.3%). The overall resection
rate was 67.7%. For rectal tumors the abdominoperineal rate was 51.4%. Mortality was higher for poorly differentiated cancer,
advanced disease, age >50 years, and emergency surgery. There was no change in the age, duration of symptoms, proportion of
patients <40 years, or the colon/rectal ratios of the cancer site. The second time period saw more adjuncts for diagnosis,
less in-hospital mortality, and better staging data.
Conclusion CRC peaks during the fifth decade of life in Kenyans. The disease is characterized by late presentation, rectal preponderance,
and inadequate pathology data. Improved patient follow-up will unravel the true pattern of disease outcome. 相似文献
11.
Twenty-seven cases of pancreatic necrosis were admitted and treated at our hospital from Jan 2010 till Jan 2015. Eight of these patients (29 %) underwent pancreatic necrosectomy. Of a total number of 957 patients admitted for acute pancreatitis, 27 patients (3 %) were diagnosed to have necrotizing pancreatitis. Of the 8 patients operated on, 5 patients (62.5 %) were treated successfully. The 3 patients who died had 3 organ (renal, respiratory and cardiovascular) failures. Nineteen patients of pancreatic necrosis responded to medical management and were successfully treated. 相似文献
12.
Volume, efficiency, and quality in hospital care are often mixed in debate. We analyze how these dimensions are interrelated
in surgical hospital management, with particular focus on volume effects: under financial constraints, efficiency is the best
form of cost control. External perception of quality is important to attract patients and gain volumes. There are numerous
explicit and implicit notions of surgical quality. The relevance of implicit criteria (functionality, reliability, consistency,
customaziability, convenience) can change in the time course of hospital competition. Outcome data theoretically are optimal
measures of quality, but surgical quality is multifactorially influenced by case mix, surgical technique, indication, process
designs, organizational structures, and volume. As quality of surgery is hard to grade, implicit criteria such as customizability
currently often overrule functionality (outcome) as the dominant market driver. Activities and volumes are inputs to produce
quality. Capability does not translate to ability in a linear function. Adequate process design is important to realize efficiency
and quality. Volumes of activities, degree of standardization, specialization, and customer involvement are relevant estimates
for process design in services. Flow-orientated management focuses primarily on resource utilization and efficiency, not on
surgical quality. The relationship between volume and outcome in surgery is imperfectly understood. Factors involve learning
effects both on process efficiency and quality, increased standardization and task specialization, process flow homogeneity,
and potential for process integration. Volume is a structural component to develop efficiency and quality. The specific capabilities
and process characteristics that contribute to surgical outcome improvement should be defined and exported. Adequate focus
should allow even small institutions to benefit from volume-associated effects. All volumes-based learning within standardized
processes will finally lead to a plateauing of quality. Only innovations will then further improve quality. Possessing volume
can set the optimal ground for continuous process research, subsequent change, innovation, and optimization, while volume
itself appears not to be a quality prerequisite. 相似文献
13.
14.
15.
16.
17.
18.
《Journal of investigative surgery》2013,26(4):180-185
ABSTRACTBackground: The incidence of inflammatory bowel disease (IBD) has risen rapidly in China over the last 15 years. Increasing numbers of people with IBD require surgery during their lifetime, but few reports of IBD in Eastern populations have been described to date. The aim of this study was to assess the short-term effects of the laparoscopic surgery for IBD in Chinese patients. Materials and methods: From February 2010 to March 2012, 35 patients with IBD underwent laparoscopic operations and the clinical data obtained for these patients were reviewed. Results: Patients with Crohn's disease (CD) (N = 21) and ulcerative colitis (UC) (N = 14) underwent laparoscopic surgery. In the CD group, the mean age was 37.4 years. Two patients (9.5%) required conversion to an open procedure. The median length of postoperative hospitalization was 9 (7–40) days. Overall morbidity was 26.3% and no patients required re-operation. In the UC group, the mean age was 55.2 years. The conversion rate was 14.3% (2/14). The median time to regular diet was 4 (3–10) days and the median length of postoperative hospitalization was 8 (7–25) days. Four patients developed postoperative complications and one patient developed ileostomy retraction requiring urgent operative intervention to rebuild the stoma. Conclusions: Laparoscopic surgery in patients with IBD can be accomplished safely and with reasonable operative times, conversion rates and morbidity rates. The main advantages of the laparoscopic approach are rapid recovery, improved cosmesis, less postoperative pain, and patient satisfaction. 相似文献
19.
Fabio Guarracino Marit Habicher Sascha Treskatsch Michael Sander Andrea Szekely Gianluca Paternoster Luca Salvi Lidia Lysenko Phillipe Gaudard Perikles Giannakopoulos Erich Kilger Amalia Rompola Helene Häberle Johann Knotzer Uwe Schirmer Jean-Luc Fellahi Ludhmila Abrahao Hajjar Stephan Kettner Matthias Heringlake 《Journal of cardiothoracic and vascular anesthesia》2021,35(4):1018-1029