共查询到20条相似文献，搜索用时 31 毫秒
1.
Angelena Crown Lauren G. Scovel Flavio G. Rocha Elliot J. Scott Debra G. Wechter Janie W. Grumley 《American journal of surgery》2019,217(1):138-141
Background
Oncoplastic breast conserving surgery (OBCS) integrates plastic surgery techniques in the resection of breast cancer and lowers the rate of re-excision while improving breast cosmesis. The goal of this study is to compare the surgical site complication rate of OBCS with that of standard BCS.Methods
A single institution chart review evaluated all patients undergoing BCS for treatment of breast cancer. Patients treated from January 2009 to December 2010, prior to adoption of oncoplastic techniques, were identified as the standard surgery (SS) group. Patients treated with OBCS from January 2013 to July 2015 were identified as the oncoplastic surgery (OS) group. All surgical site complications were recorded.Results
Overall, 561 patients were evaluated. The SS group comprised 273 patients compared with 288 patients in the OS group. Surgical site complications occurred in 49 patients (17.9%) in the SS group compared with 23 patients (8.0%) in the OS group (p?<?0.001).Discussion
Overall, BCS has a low rate of significant surgical site complications. OBCS has a lower rate of surgical site complications compared to standard BCS. 相似文献2.
Rosalind P. Candelaria Palita Hansakul Alastair M. Thompson Huong Le-Petross Vicente Valero Roland Bassett Monica L. Huang Lumarie Santiago Beatriz E. Adrada 《American journal of surgery》2018,215(4):693-698
Background
To determine the cancer yield of stereotactic biopsy of suspicious calcifications identified within 24 months after breast conservation therapy (BCT).Methods
Retrospective review of stereotactic biopsies performed during 2009–2013 for suspicious calcifications in the ipsilateral breast of patients who completed BCT.Results
94/2773 (3.4%) had stereotactic biopsies for suspicious calcifications in the ipsilateral breast; 7/94 (7.4%) had DCIS (6) or invasive (1) cancer; 5/7 occurred in the same breast quadrant as the primary. All 7 originally had negative surgical margins (≥2 mm); 6 received whole breast irradiation, and 2 received adjuvant chemotherapy + endocrine therapy. Median time to detection was 11 months (range, 6–20 months). There was a strong association between calcification morphology (particularly pleomorphic) and likelihood of malignancy (p = 0.008).Conclusions
Stereotactic biopsy of calcifications identified within 24 months post-BCT has a 7% cancer yield. Tissue biopsy should be performed rather than imaging followup alone when breast calcifications have suspicious morphology. 相似文献3.
Masashi Uehara Jun Takahashi Yohei Akazawa Shugo Kuraishi Shota Ikegami Toshimasa Futatsugi Hiroki Oba Hiroyuki Kato 《Journal of orthopaedic science》2018,23(2):294-298
Background
As the surgical treatment of scoliosis after a Fontan procedure is very challenging due to the risk of various perioperative complications, case reports are scarce. We herein describe three patients who were successfully treated for scoliosis following a Fontan procedure and discuss their clinical and radiological outcomes.Methods
We retrospectively reviewed three cases of scoliosis treated by posterior spinal fusion after a Fontan procedure.Results
Mean preoperative major curve Cobb angle was 83.7°, mean surgical time was 233.0 min, and mean blood loss was 1167 g. The mean correction rate of the major curve was 48.0%. Surgical outcome as evaluated by Scoliosis Research Society-22 patient questionnaires revealed acceptable results without any severe complications.Conclusions
Corrective surgery for scoliosis after a Fontan procedure becomes a stronger option if cardiac insufficiency is prevented during the perioperative period and a conservative plan is carried out with minimal invasiveness and operation time. 相似文献4.
Tara M. Veasey James N. Fleming Sara E. Strout Ryan Miller Nicole A. Pilch Holly B. Meadows Caitlin R. Mardis Benjamin A. Mardis Sunil Shenvi John McGillicuddy Kenneth D. Chavin Prabhakar Baliga David J. Taber 《American journal of surgery》2018,215(4):663-668
Background
This study evaluated the impact of body mass index (BMI) and patient functional status on the risk for surgical complications after kidney transplant.Methods
This retrospective cohort study of adult kidney transplant recipients grouped patients by baseline Karnofsky status (low function ≤ 70%) and further stratified by morbid obesity (BMI ≥ 35 kg/m2) to assess surgical complication risk.Results
736 patients were included with surgical complications occurring in 25%. Logistic regression analysis with interaction terms demonstrated that morbid obesity and low functional status conditionally impact risk with an OR of 2.8 [95% CI (1.1–7.3)]. Within the functional status cohort, BMI ≥35 kg/m2 was associated with increased risk of surgical complication, superficial wound infection, and DGF. Independent predictors for surgical complications included diabetes and morbid obesity with low functional status. There was no significant difference in graft loss or death across the cohorts.Conclusions
While neither morbid obesity nor poor functional status alone predicts increased complications, the combined presence is associated with significant increase in risk for surgical complications after renal transplantation. 相似文献5.
Background
The global rise in infectious disease has led the Center for Disease Control and Prevention and the World Health Organization to release new guidelines for the prevention of surgical site infection.Methods
In this article, we summarize current recommendations based on level of evidence, review unresolved and unaddressed issues, and supplement them with new literature.Results
Although the guidelines discuss major issues in reducing surgical site infection, many questions remain unanswered.Conclusion
These guidelines will hopefully help in setting a standard of care based on best evidence available and focus investigators on areas where evidence is lacking. 相似文献6.
Elaine McKevitt Carol Dingee Rebecca Warburton Jin-Si Pao Carl J. Brown Christine Wilson Urve Kuusk 《American journal of surgery》2018,215(5):805-811
Introduction
Concern has been raised about delays for patients presenting with breast symptoms in Canada. Our objective was to determine if our Rapid Access Breast Clinic (RABC) improved care for patients presenting with breast symptoms compared to the traditional system (TS).Methods
A retrospective chart review tabulated demographic, surgical, pathology and radiologic information. Wait times to care were determined for patients presenting with symptomatic and screen detected breast problems.Results
Time from presentation to surgeon evaluation was shorter in the RABC group for patients with breast symptoms (81 vs 35 days, p?<?.0001) and abnormal screens (72 vs 40 days, p?=?.092). Cancer patients with abnormal screens had shorter wait times than patients with breast symptoms in the TS (47 vs 70 days, p?=?.036).Conclusion
Coordination of imaging and clinical care reduces wait times in patients with both abnormal screening mammograms and symptomatic breast presentations and should be expanded in our province. 相似文献7.
Elleson Schurtz Jerome Differding Eric Jacobson Christopher Maki Mentor Ahmeti 《American journal of surgery》2018,215(1):113-115
Background
Surgical site complications in the form of wound infections are a major burden to the healthcare system. Negative pressure wound therapy (NPWT) as delivered by a surgical incision management system (SIMS) is a novel approach to improve wound healing when applied to closed incisions. However, data is limited in its application to laparotomy incisions in the acute care surgery setting.Methods
A retrospective case-control study was performed to evaluate the outcomes of SIMS with regard to surgical site infections in a series of 48 consecutive patients in which SIMS was applied to closed laparotomy incisions in the acute care surgery setting.Results
48 cases were matched with equivalent controls without significant differences between groups. Patients who received the SIMS had significantly lower rates of surgical site infection and readmission rates.Conclusions
Negative pressure surgical incision management systems may be a novel approach to reduce surgical site infections in acute care surgery. 相似文献8.
Mohamed Shaher Hasanain Dragos Apostu Attaallh Alrefaee Samih Tarabichi 《The Journal of arthroplasty》2018,33(7):2119-2124
Background
Total knee arthroplasty (TKA) is a commonly performed procedure worldwide for the treatment of knee joint disease. Tourniquet is frequently used during the entire procedure to reduce blood loss and increase surgical comfort. On the other hand, tourniquet-related complications exist, and there are still controversies whether benefits outweigh the risks.Methods
Patients undergoing simultaneous TKAs had one knee assigned to group A (use of tourniquet during the entire procedure) and the other knee assigned to group B (use of tourniquet only during cementation). Blood loss, intraoperative complications, implant alignment, soft tissue swelling, pain score, and range of motion were analyzed.Results
Fifty-four patients undergoing 108 TKAs were included in the study. Total blood loss was almost 2 times higher in group B knees compared with group A. No difference was observed between groups in implant alignment, soft tissue swelling, pain, range of motion, or other early postoperative complications.Conclusion
Tourniquet use in TKAs during the entire surgical procedure reduces total blood loss, without an increase in early postoperative complications. 相似文献9.
Philip Dawe Andrew Kirkpatrick Max Talbot Andrew Beckett Naisan Garraway Heather Wong Syed Morad Hameed 《American journal of surgery》2018,215(5):927-929
Background
Damage-control and emergency surgical procedures in trauma have the potential to save lives. They may occasionally not be performed due to clinician inexperience or lack of comfort and knowledge.Methods
Canadian Armed Forces (CAF) non-surgeon Medical Officers (MOs) participated in a live tissue training exercise. They received tele-mentoring assistance using a secure video-conferencing application on a smartphone/tablet platform. Feasibility of tele-mentored surgery was studied by measuring their effectiveness at completing a set series of tasks in this pilot study. Additionally, their comfort and willingness to perform studied procedures was gauged using pre- and post-study surveys.Results
With no pre-procedural teaching, participants were able to complete surgical airway, chest tube insertion and resuscitative thoracotomy with 100% effectiveness with no noted complications. Comfort level and willingness to perform these procedures were improved with tele-mentoring. Participants felt that tele-mentored surgery would benefit their performance of resuscitative thoracotomy most.Conclusion
The use of tele-mentored surgery to assist non-surgeon clinicians in the performance of damage-control and emergency surgical procedures is feasible. More study is required to validate its effectiveness. 相似文献10.
Carla Pajak JinSi Pao Amandeep Ghuman Elaine C. McKevitt Urve Kuusk Carol K. Dingee Rebecca Warburton 《American journal of surgery》2018,215(5):922-925
Introduction
Breast Conserving Surgery (BCS) is considered standard of care for women with early stage breast cancer. Between 20 and 50% of women treated with BCS will require re-operation for positive or close margins and it has been suggested that routine cavity shave margins may reduce the frequency of positive margins.Methods
Retrospective chart review of a prospectively maintained surgical database of patients undergoing BCS for early stage breast cancer, at a single institution, between January 2012 and December 2015. Cohort was followed until June 2016 to capture re-operations.Results
Among 2096 patients with stage 0-III breast cancers, 872 (42%) underwent primary mastectomies and 1224 (58%) underwent primary BCS. Margins were positive in 128 (11%) and close in 442 (36%). Re-operation rate for patients after BCS was 19%.Conclusion
A lower than predicted positive margin rate suggests that routine shave margins are not warranted at our institution. 相似文献11.
Background
Average costs associated with common procedures can vary by surgeon without a corresponding variation in outcome or case complexity.Methods
De-identified cost and equipment utilization data were collected from our hospital for elective laparoscopic cholecystectomy performed by 17 different surgeons over a 6-month period. A group of surgeons used this data to design a standardized equipment pick list that became optional (not mandated) for laparoscopic cholecystectomy. Cost and consumable surgical supply utilization data were collected for six months prior to and following the creation of the standardized pick-list.Results
280 elective laparoscopic cholecystectomies were performed during the study interval. In the 6 months after standardized pick list creation, the cost of disposable supplies utilized per case decreased by 32%.Conclusions
Surgical cost savings can be achieved with standardized procedure pick lists and attention to the cost of consumable surgical supplies. 相似文献12.
Background
Athletes often use video to improve their technique. We hypothesized that surgical novices given feedback using video-replay would outperform surgical novices given verbal feedback in the performance of a laparoscopic task.Methods
Our study used a prospective, randomized control design. The surgical task involved the laparoscopic dissection of a pig gallbladder. Our participants performed a dissection, pre- and post-traditional or video feedback. Each recording was independently scored by two staff surgeons using the previously validated rating tools.Results
There was no significant difference between video feedback or traditional feedback groups in their mean overall or task specific scores. Both traditional and video-feedback groups had a trend towards improved performance post-feedback.Conclusions
No significant difference in performance by both our global assessment metrics or task-specific metrics was observed. Video feedback requires further study to investigate its impact on surgical training. 相似文献13.
A.K. Gardner E.M. Ritter B.J. Dunkin D.S. Smink J.N. Lau J.T. Paige R. Phitayakorn R.D. Acton D. Stefanidis D.W. Gee 《American journal of surgery》2018,215(2):259-265
Background
The role of simulation-based education continues to expand exponentially. To excel in this environment as a surgical simulation leader requires unique knowledge, skills, and abilities that are different from those used in traditional clinically-based education.Methods
Leaders in surgical simulation were invited to participate as discussants in a pre-conference course offered by the Association for Surgical Education. Highlights from their discussions were recorded.Results
Recommendations were provided on topics such as building a simulation team, preparing for accreditation requirements, what to ask for during early stages of development, identifying tools and resources needed to meet educational goals, expanding surgical simulation programming, and building educational curricula.Conclusion
These recommendations provide new leaders in simulation with a unique combination of up-to-date best practices in simulation-based education, as well as valuable advice gained from lessons learned from the personal experiences of national leaders in the field of surgical simulation and education. 相似文献14.
T. Bessede Y. Hammoudi D. Bedretdinova B. Parier H. Francois A. Durrbach G. Benoit 《Transplantation proceedings》2017,49(9):2018-2024
Background
Only surgically irrelevant risk factors including sex, African-American ancestry, or exceptional U-stitch anastomosis have been identified to associate with urinary complications after kidney transplantation. The objective was to identify modifiable and nonmodifiable risk factors associated with urinary complications after kidney transplantation.Methods
A single-center study of 3,129 kidney transplants performed over 40 years was conducted to identify independent risk factors using χ2 tests and logistic regression analysis.Results
We identified the quality of the transplant's ureter, cystographic abnormalities in the recipient, and repeat transplantations as independent risk factors for overall urinary complications occurring after kidney transplantation in multivariable analysis. Obesity was associated with an increased risk of urinary fistula, while the presence of a JJ stent was associated with a reduced risk of urinary fistula. The risk of urinary surgical complications for kidney transplantations was reduced when the kidney was recovered from a living related compared to a deceased donor.Conclusions
The risk factors identified in the present study will allow candidates for kidney transplantation to be more informed and will also allow for surgical modifications to limit the occurrence of urinary complications. 相似文献15.
A. Lauro A.D. Pinna E. Tossani V. Stanghellini M. Manno G. Caio L. Golfieri C. Zanfi N. Cautero A. Bagni U. Volta M. Di Simone L. Pironi R.F. Cogliandro M. Serra A. Venturoli S. Grandi R. De Giorgio 《Transplantation proceedings》2018,50(1):226-233
Background
Clinical and psychosocial outcomes of a multimodal surgical approach for chronic intestinal pseudo-obstruction were analyzed in 24 patients who were followed over a 2- to 12-year period in a single center after surgery or intestinal/multivisceral transplant (CTx).Methods
The main reasons for surgery were sub-occlusion in surgery and parenteral nutrition–related irreversible complications with chronic intestinal failure in CTx.Results
At the end of follow-up (February 2015), 45.5% of CTx patients were alive: after transplantation, improvement in intestinal function was observed including a tendency toward recovery of oral diet (81.8%) with reduced parenteral nutrition support (36.4%) in the face of significant mortality rates and financial costs (mean, 202.000 euros), frequent hospitalization (mean, 8.8/re-admissions/patient), as well as limited effects on pain or physical wellness.Conclusions
Through psychological tests, transplant recipients perceived a significant improvement of mental health and emotional state, showing that emotional factors were more affected than were functional/cognitive impairment and social interaction. 相似文献16.
Samuel Rosas Alejandro Marquez-Lara Daniel N. Bracey Jennifer Kurowicki Martin W. Roche Cynthia L. Emory 《The Journal of arthroplasty》2018,33(3):893-896
Background
Rates of total hip arthroplasty (THA) are projected to increase in the coming decades. Multiple studies have focused on identifying risk factors for adverse events after joint arthroplasty, and recent attention has been directed toward cancer. Very limited data have been published examining the effects of history of malignancy on outcomes after THA. With a concomitant increase in breast cancer diagnosis and treatments in recent years, it is expected that orthopedic surgeons will likely see more breast cancer survivors in clinic. The purpose of this study is to examine the effects of a personal history of breast cancer on 90-day outcomes after THA.Methods
We conducted a retrospective case-control study of the entire Medicare records. The endpoints of this study included length of stay, medical complications, surgical complications, and costs (examined here as reimbursements). Patients were matched by age and gender in order to decrease confounding. A 1:1 matching was performed.Results
After age and demographics matching, our findings demonstrated that patients with a history of breast cancer have increased rates of pulmonary embolism (0.59% vs 0.45%, P = .003), increased use of chest computed tomography (1.72% vs 1.18%, P < .001), and higher mean 90-day reimbursements (mean $15,432 vs mean $14,701, P = .011) in the 90 days following surgery. Other medical and surgical complications were equally distributed in both cohorts.Conclusion
Surgeons should be aware of the increased rate of pulmonary embolism and have a more aggressive thromboprophylaxis protocol in these patients. 相似文献17.
Linda T. Qu Stephanie Peters Adrienne N. Cobb Constantine V. Godellas Claudia B. Perez Faaiza T. Vaince 《American journal of surgery》2018,215(3):530-533
Background
Axillary disease can be downstaged with neoadjuvant treatment for breast cancer. We attempted to identify factors to consider in determining whether to perform a sentinel lymph node biopsy in patients with biopsy proven axillary metastases (cN+) prior to neoadjuvant treatment.Methods
A retrospective chart review was conducted on patients at a single tertiary care center who underwent neoadjuvant treatment followed by surgery between 9/2013 and 2/2017.Results
47% of patients with node positive disease prior to neoadjuvant treatment were downstaged to node negative (ypN0) disease. These patients were more likely to have triple negative or Her2 positive disease than those patients who remained node positive (ypN+) as these were more likely to have hormone receptor positive disease. These patients were also more likely to demonstrate complete clinical imaging response of the primary tumor and axilla on preoperative breast MRI.Conclusions
Tumor biology and clinical response noted on breast MRI can help guide the decision to perform sentinel lymph node biopsy in patients with axillary node positive disease prior to neoadjuvant treatment. 相似文献18.
John L. Falcone 《American journal of surgery》2018,215(2):341-346
Background
There is a decreasing institutional percentage of surgical resident recipients of The Arnold P. Gold Humanism and Excellence in Teaching Award over time. The hypothesis was that this trend was a national phenomenon.Methods
This was a retrospective study from 2004 - 2015, utilizing data from the Arnold P. Gold Foundation. Multiple regression was performed using the estimated ratio of eligible surgical to non-surgical residents and the year as explanatory variables, utilizing an α = 0.05.Results
The percentage of surgical award winners was lower in the second study half compared to the first half (40.2% vs. 47.2%) (p = 0.02). Multiple regression showed that when controlling for the number of eligible residents, the number of resident awardees decreased over time (p = 0.01).Conclusion
There is a clear national trend that surgical residents are receiving the Arnold P. Gold Humanism and Excellence in Teaching Award less over time. 相似文献19.
20.
Michael Derickson Cody Phillips Morgan Barron John Kuckelman Matthew Martin Mia DeBarros 《American journal of surgery》2018,215(5):887-890