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1.
T. Chan M.S. Bleszynski D.S. Youssef M. Segedi S. Chung C.H. Scudamore A.K. Buczkowski 《American journal of surgery》2018,215(5):782-785
Introduction
Damage control laparotomy with vacuum assisted closure (VAC) is used for selective cases in trauma. In liver transplantation, VAC has also been applied for management of intra-operative hemorrhage. The primary objective was to evaluate peri-operative blood loss and blood product utilization in VAC compared to primary abdominal closure (PAC) at the index transplant operation.Methods
Retrospective review of all adults undergoing deceased donor liver transplantation (2007–2011) at a single center tertiary care institution.Results
201 deceased donor liver transplantations were performed, with 167 PAC and 34 VAC cases. Intra-operative blood loss (4.4L vs 10.7L), cell saver return (1399?ml vs 3998?ml), FFP (7.6U vs 15.9U) and PLT requirements (8.5U vs 18.3U), were all significantly elevated in VAC compared to PAC. VAC patients had significantly increased RBC, FFP, PLT, and total volume requirements during initial ICU admission. 30 PAC cases required on demand laparotomy and most commonly for post-operative bleeding.Conclusion
In liver transplantation, application of VAC secondary to massive intra-operative exsanguination was safely utilized. Further evaluation is required to identify long-term morbidity and mortality. 相似文献2.
Leslie T.F. Leung Anthony Papp 《Burns : journal of the International Society for Burn Injuries》2018,44(3):646-650
Background
Accelerants are flammable substances that may cause explosion when added to existing fires. The relationships between drug abuse and accelerant-related burns are not well elucidated in the literature. Of these burns, a portion is related to drug manufacturing, which have been shown to be associated with increased burn complications.Objectives
1) To evaluate the demographics and clinical outcomes of accelerant-related burns in a Provincial Burn Centre.2) To compare the clinical outcomes with a control group of non-accelerant related burns.3) To analyze a subgroup of patients with history of drug abuse and drug manufacturing.Methods
Retrospective case control study. Patient data associated with accelerant-related burns from 2009 to 2014 were obtained from the British Columbia Burn Registry. These patients were compared with a control group of non-accelerant related burns. Clinical outcomes that were evaluated include inhalational injury, ICU length of stay, ventilator support, surgeries needed, and burn complications. Chi-square test was used to evaluate categorical data and Student’s t-test was used to evaluate mean quantitative data with the p value set at 0.05. A logistic regression model was used to evaluate factors affecting burn complications.Results
Accelerant-related burns represented 28.2% of all burn admissions (N = 532) from 2009 to 2014. The accelerant group had higher percentage of patients with history of drug abuse and was associated with higher TBSA burns, ventilator support, ICU stay and pneumonia rates compared to the non-accelerant group. Within the accelerant group, there was no difference in clinical outcomes amongst people with or without history of drug abuse. Four cases were associated with methamphetamine manufacturing, all of which underwent ICU stay and ventilator support.Conclusions
Accelerant-related burns cause significant burden to the burn center. A significant proportion of these patients have history of drug abuse. 相似文献3.
Benjamin C. Jordan Joseph Brungardt Jared Reyes Stephen D. Helmer James M. Haan 《American journal of surgery》2018,215(1):48-52
Background
The specific contribution of dementia towards mortality in trauma patients is not well defined. The purpose of the study was to evaluate dementia as a predictor of mortality in trauma patients when compared to case-matched controls.Methods
A 5-year retrospective review was conducted of adult trauma patients with a diagnosis of dementia at an American College of Surgeons-verified level I trauma center. Patients with dementia were matched with non-dementia patients and compared on mortality, ICU length of stay, and hospital length of stay.Results
A total of 195 patients with dementia were matched to non-dementia controls. Comorbidities and complications (11.8% vs 12.4%) were comparable between both groups. Dementia patients spent fewer days on the ventilator (1 vs 4.5, P = 0.031). The length of ICU stay (2 days), hospital length of stay (3 days), and mortality (5.1%) were the same for both groups (P > 0.05).Conclusions
Dementia does not appear to increase the risk of mortality in trauma patients. Further studies should examine post-discharge outcomes in dementia patients. 相似文献4.
Husayn A. Ladhani Nitin Sajankila Brenda M. Zosa Jack C. He Charles J. Yowler Christopher Brandt Jeffrey A. Claridge Anjay K. Khandelwal 《American journal of surgery》2018,215(3):478-481
Background
We evaluated whether qSOFA ≥2 and an increase in SOFA (ΔSOFA) ≥2 can help predict bacteremia in a critically ill burn population.Methods
Patients age ≥15 and TBSA ≥15% admitted between 2009 and 2015 were included. All blood cultures were recorded, and positive and negative blood culture days were defined based on the culture results. SOFA and qSOFA scores were compared between positive and negative blood culture days.Results
There were 50 patients in our study with a mean age of 47yrs and mean TBSA burn of 37%. Bacteremic patients had larger TBSA and full thickness burns, higher revised Baux score, and longer hospital LOS, without a difference in mortality, compared to non-bacteremic patients. There was no difference in qSOFA and SOFA scores between positive and negative blood culture days. A ΔSOFA ≥5 was highly specific for positive blood culture days.Conclusions
SOFA and qSOFA have limited ability to predict bacteremia in critically ill burn patients. 相似文献5.
Steve R. Siegal James P. Dolan Elizabeth N. Dewey Alexander R. Guimaraes Brandon H. Tieu Paul H. Schipper John G. Hunter 《American journal of surgery》2018,215(5):813-817
Background
Sarcopenia is associated with increased morbidity and mortality in hepatic, pancreatic and colorectal cancer. We examined the effect of sarcopenia on morbidity, mortality, and recurrence after resection for esophageal cancer.Methods
Retrospective review of consecutive esophagectomies from 2010 to 2015. Computed tomography studies were analyzed for sarcopenia. Morbidity was analyzed using Fischer's test and survival data with Kaplan Meier curves.Results
The sarcopenic group (n?=?127) had lower BMI, later stage disease, and higher incidence of neoadjuvant radiation than those without sarcopenia (n?=?46). There were no differences in morbidity or mortality between the groups (p?=?.75 and p?=?.31, respectively). Mean length of stay was similar (p?=?.70). Disease free and overall survival were similar (p?=?.20 and p?=?.39, respectively).Conclusion
There is no association between sarcopenia and increased morbidity, mortality and disease-free survival in patients undergoing esophagectomy for cancer. Sarcopenia in esophageal cancer may not portend worse outcomes that have been reported in other solid tumors. 相似文献6.
C.-H. Shen K.-R. Dong Y.-F. Tao G. Chen R.-D. Li Q.-B. Zhang X.-F. Zhang S. Zheng Z.-X. Wang 《Transplantation proceedings》2017,49(1):185-187
Background
Liver transplantation in combination with chemotherapy in postoperative biliary rhabdomyosarcoma recurrence of children was evaluated.Methods
An 8-year-old girl with biliary rhabdomyosarcoma underwent pancreatico-duodenectomy with postoperative vincristine (VCR), adriamycin (Act-D), and cyclophosphamide (CTX) (VAC chemotherapy) (VCR, 1 mg; Act-D, 0.7 mg; CTX, 1500 mg). Two years later, liver metastasis in the left and right lobes was found and was followed by VAC chemotherapy (CTX, 1800 mg; Act-D, 0.9 mg; VCR, 1.2 mg), with no change of the tumor size. One and a half years later, liver transplantation performed with postoperative pathology confirmed embryonal rhabdomyosarcoma recurrence and was followed by VAC chemotherapy (CTX, 1400 mg; Act-D, 0.7 mg; VCR, 1.9 mg) and immunosuppression treatment.Results
The liver transplantation went well, with no major complications. At the time of this report, the patient had survived for 6 months, with a good quality of life and no tumor recurrence.Conclusions
For unresectable biliary rhabdomyosarcoma without extra-hepatic metastases, liver transplantation could be an effective treatment. Liver transplantation completely removes the tumor and reduces the long-term side effects of chemotherapy drugs. 相似文献7.
W.W. Sheaffer R.W. Day K.L. Harold J.T. Kidwell J.L. Tiede T.R. Benjamin S. Bersoux J.A. Madura 《American journal of surgery》2018,215(3):452-455
Objective
Enhanced recovery has been utilized to decrease length of stay and cost in bariatric surgery. We have recently focused efforts on pre-operative education with regards to discharge on the first post-operative day. The aim of this study was to determine the effectiveness of pre-operative education on discharge timing and readmission rates.Methods
A retrospective review was conducted after revising discharge expectation education. Patients undergoing first time bariatric operations were included. Early group education focused on average patient stay of 2 postoperative days. Revised education informed patients they could go home on the first post-operative day.Results
A total of 125 patients met inclusion criteria. Implementation of preoperative education was associated with a decrease in mean LOS and greater percentage of patients discharged on post-operative day one. There was no difference in readmission and complication rates.Conclusion
Effective pre-operative education can decrease length of stay in first time laparoscopic bariatric surgery. 相似文献8.
Background
Historical studies suggest no difference in disease outcome between neoadjuvant and adjuvant approaches in breast cancer. We hypothesize neoadjuvant chemotherapy (NCT) may offer several benefits, possibly improving quality of life outcomes.Methods
Retrospective review of Tumor Registry data of breast cancer patients from 2011 to 2015. Pathologists reviewed cases from 2012 to 2013 to provide additional RCB (residual cancer burden) scores.Results
From 2011 to 2015 there were 2707 breast cancer cases and 455 patients received NCT. RCB score was documented in 348 with excellent outcome in 41% (pCR in 115 patients, 28 RCB I). There were 137 RCB II and 68 RCB III. Clinically positive nodes were present in 202 of 455 and 77 (38%) had clearance of nodal disease. Of these 45 had axillary dissections.Discussion
Neoadjuvant therapy was associated with excellent response rates. Thirty eight percent of patients with positive nodes converted to node negative although over 50% underwent axillary dissection. Higher utilization of NCT could decrease need for axillary dissection thereby lowering incidence of lymphedema and improving quality of life for survivors. 相似文献9.
Carlos J. Lavernia Anneliese D. Heiner Jesus M. Villa Jose C. Alcerro Mark D. Rossi 《The Journal of arthroplasty》2017,32(1):6-10
Background
The purpose of this study was to determine the influence of preoperative glycemic control in diabetic patients undergoing a primary total hip or knee arthroplasty. We wanted to study patient-perceived outcomes in the medium term, the length of stay, hospital costs, and rate of short-term postoperative complications.Methods
One hundred twenty consecutive primary total joint arthroplasties (TJAs) performed in type 2 diabetic patients were stratified into 2 groups representing optimal and suboptimal preoperative glycemic control, based on serum levels of glycated hemoglobin (HbA1c), and those groups compared.Results
The mean follow-up time was 5.9 years (range, 2.1-10.7 years). Both groups demonstrated improvement in all patient-perceived outcome measures after TJA, with no significant difference detected in any change of a measure between the groups. No significant difference was detected in the length of stay, hospital costs, or rate of short-term postoperative complications between the groups.Conclusion
Preoperative glycemic control in type 2 diabetic patients undergoing TJA did not affect patient-perceived outcomes in the medium term. Optimal vs suboptimal glycemic control in these patients also had no effect on the length of stay, hospital costs, or rate of short-term postoperative complications. 相似文献10.
Background
Anemia is the most common extraintestinal manifestation in patients with inflammatory bowel disease (IBD), and has been linked to severity of the disease. The aim of the study was to assess the impact of anemia on postoperative outcomes in patients with IBD.Methods
We retrospectively reviewed patients with IBD from the NSQIP database over an 8-year period. Patients were grouped based on the presence of anemia. The impact of anemia on postoperative morbidity, mortality and length of stay was assessed.Results
A total of 15,761 patients met our criteria. Half of the patients were anemic upon presentation. Anemic patients were more likely to have a history of steroid use, present with sepsis and require an emergency operation. In multivariate analysis, anemia was a significant predictor of overall morbidity, serious morbidity and increased length of stay.Conclusions
Anemic patients with IBD present more often with sepsis and require emergency surgery compared to their peers. In addition, anemia serves as an independent predictor of overall complications, serious morbidity and increased length of stay following abdominal operations. 相似文献11.
Background
The Joint Commission's SCIP Inf-9 mandated early removal of indwelling urinary catheters (IUCs), but the impact of compliance on catheter-associated urinary tract infection (CAUTI) and postoperative urinary retention (POUR) are unknown.Methods
Retrospective pre- and post-intervention study at a single tertiary academic medical center of all patients undergoing general surgery procedures with an IUC placed at the time of surgery who were admitted for at least two days before and after a Best Practice Advisory was put in place to improve compliance with SCIP Inf-9.Results
A total of 1036 patients were included (468 pre-intervention; 568 post-intervention). POUR occurred in 13% of patients and CAUTI in 0.8%. There was no change in POUR, CAUTI, or catheter utilization after the Best Practice Advisory was initiated. Both POUR and CAUTI predicted longer lengths of stay.Conclusions
Near-perfect SCIP Inf-9 compliance had no effect on the CAUTI rate at our institution. 相似文献12.
Richard J. Hanly Salman K. Marvi Sarah L. Whitehouse Ross W. Crawford 《The Journal of arthroplasty》2017,32(9):2712-2716
Background
It is increasingly apparent that the effect of obesity in arthroplasty is joint-specific. This study evaluates the effects of morbid obesity on primary total knee arthroplasty by comparing short-term outcomes between a morbidly obese (body mass index ≥40 kg/m2) and a normal weight (body mass index 18.5-<25 kg/m2) cohort at our institution between January 2003 and December 2010.Methods
One hundred seventeen morbidly obese patients were compared with 94 normal weight patients. Operative time, length of stay, complications, 30-day readmission, and readmission length were compared.Results
Morbid obesity conveyed no significant increase in 30-day readmission. Operative time was increased at 100 minutes in the morbidly obese group, compared with 90.5 minutes (P = .026).Conclusion
Morbid obesity conveyed no increased risk of length of stay or readmission in this cohort. 相似文献13.
Sarah Walcott-Sapp Nathalie Johnson Jennifer Garreau 《American journal of surgery》2018,215(5):892-897
Introduction
Cancer diagnosis affects employment status. Our health network offers supportive services to cancer patients. We hypothesized patients who used these services were more likely to continue to work during and after treatment.Methods
A mailed survey was used to assess employment before, during, and after treatment, and support services used. Chi-square analysis was performed.Results
The response rate was 34% (273/782). 87% of patients worked full or part time before cancer diagnosis, 68.8% continued to work during treatment, and 73.9% returned to work after treatment. 61% of patients used at least one type of support service. Patients who had no change in work status during treatment and who returned to work less than one month after treatment were more likely to use services.Conclusions
Most patients used support services, continued to work during treatment, and returned to pre-cancer employment status. Physicians should encourage patients to pursue supportive therapies. 相似文献14.
Avinash Bhakta Owen Glotzer Ashar Ata Marcel Tafen Steven C. Stain Paul T. Singh 《American journal of surgery》2018,215(4):643-646
Background
Postoperative pain management is a major contributor to recovery and discharge in bariatric surgery. Local anesthetic agents are of particular interest: they're non-sedating and may reduce postoperative pain and hospital length of stay (LOS).Design
Researchers queried the Bariatric Surgery Service Database for patients undergoing laparoscopic weight loss surgery from January 2012–December 2014. Patients were divided between those who did and did not receive liposomal bupivacaine intra-operatively. Measures included demographics, narcotic use, LOS, antiemetic use, and pain scales.Results
The liposomal group consisted of 233 patients and the PCA group consisted of 243 patients. The liposomal group had significantly less narcotic use than the PCA group in terms of IV morphine equivalents. This did not translate into a reduction in LOS in the liposomal group.Conclusions
TAP block using liposomal bupivacaine provides effective analgesia comparable to PCA. 相似文献15.
S. González Martínez A. Molina Raya A. Becerra Massare K. Muffak Granero T. Villegas Herrera J.M. Villar del Moral Y. Fundora Suárez 《Transplantation proceedings》2018,50(2):595-597
Objectives
The score in the Model of End-stage Liver Disease, or MELD, is a good indicator of the survival in patients on the liver transplant waiting list. In this study, an analysis is performed on the benefits of liver transplant on those patients with a very high MELD score and who thus start from a very severe baseline state that could affect the surgical outcome.Materials and methods
A prospective study was conducted on a cohort of 331 patients that received a liver transplant between 2002 and 2014. The patients were divided into 2 groups according to the MELD score (<28 vs ≥28), and differences in age, postoperative complications, stay in the intensive care unit (ICU), hospital stay, and survival were compared.Results
Of the total of 331 patients, 21 (6.3%) had a MELD score ≥ 28. The mean age of the group with MELD score ≥ 28 was lower than the age in the group with MEDL score < 28 (42.5 vs 53.7 years; P < .0001). No significant increase was observed in postoperative complications. Although there were also no differences in survival, the group with MELD score ≥ 28 did have a longer stay in ICU and a longer hospital stay (with a mean of 6.7 days in ICU and 41.5 days admission vs 4.1 and 26.9, respectively).Conclusions
A very high MELD score is associated with a longer stay in ICU and more days of hospital admission, although no differences were observed in postoperative complications or survival. Therefore, there does not seem to be any contraindication in transplantation in this group of patients. 相似文献16.
Lauren Slakey Pointer Zaid Al-Qurayshi David Taylor Pointer Emad Kandil Douglas Philip Slakey 《American journal of surgery》2018,215(1):120-124
Purpose
This study evaluates the association of environmental, social and health risk factors in relation to outcomes of pancreatic surgery.Methods
Patients who underwent pancreatectomy with a 30 day postoperative follow up in Florida, New York and Washington states were identified using the State Inpatient Databases (SID) from 2010 to 2011. This data was merged with community health indicators complied from the County Health Ranking database. Fourteen community health indicators were used to determine higher risk communities. Communities were then divided into low and high risk communities based on a scoring system using accumulative community risk.Results
Among 3494 patients included recipients in high-risk communities were more likely African American (p < 0.001), younger (age 40–59; p = 0.001), and had Medicaid as primary insurance (p = 0.001). Management of patients in high-risk communities was associated with increased risk of postoperative complications (p < 0.001), ICU admissions (p < 0.001), increased length of stay (p < 0.001).Conclusion
Health indicators from patients' communities are predictors of increased risk of perioperative complications for individuals undergoing pancreas surgery. 相似文献17.
Background
The optimal timing for performing appendectomy in adults remains controversial.Method
A one-year retrospective review of adult patients with acute appendicitis who underwent appendectomy. The cohort was divided by time-to-intervention into two groups: patients who underwent appendectomy within 8 h (group 1), and those who had surgery after 8 h (group 2). Outcome measures including perioperative morbidity and mortality, post-operative length of stay, and the 30-day readmission rate were compared between the two groups.Results
A total of 116 patients who underwent appendectomy met the inclusion criteria: 75 patients (65%) in group 1, and 41 (35%) in group 2. There were no differences between group 1 & 2 in perioperative complications (6.7% vs. 9.8%, P = 0.483), postoperative length of stay (median [IQR]; 19.5 [11.5–40.5] vs. 20.0 [11.25–58.5] hours, P = 0.632), or 30-day readmission rate (2.7% vs. 4.9%, P = 0.543). There were no deaths in either group.Conclusion
Delayed appendectomy performed more than 8 h was not associated with increased perioperative complications, postoperative length of stay, 30-day readmission rate, or mortality. 相似文献18.
A. Faulkner M.J. Reidy P.S.E. Davies W. Wang N. Buddhadev L. Johnston B. Clift 《The surgeon》2018,16(4):227-231
Introduction
10-year study examining differences in total knee arthroplasty (TKA) functional outcomes and survivorship in patients operated on by consultant and trainee orthopaedic surgeons.Method
Data was prospectively collected from all elective TKAs performed at our three linked institutions. Patient demographics, surgeon grade, and length of hospital stay were recorded. Outcomes pre-operatively and at 1, 3, 5, 7 and 10 years included mortality, need for revision surgery and function as documented by the patients’ Knee Society Score.Results
686 patients were included in the study. 450 (65.5%) patients were operated by consultant surgeons and 236 (34.4%) by trainees. On multivariate analysis no significant differences were observed between groups in length of hospital stay (p = 0.695), implant survival (p = 0.422), and function (p = 0.507) at 10 years. On Cox regression analysis no significant difference was observed in mortality (p = 0.209) at 10 years. 4 patients over this time period were lost to formal follow up.Conclusion
No significant difference was observed in the TKA outcomes between consultants and trainees 10 years post-operatively. 相似文献19.
Background
The aim of this prospective cohort study is to evaluate the outcome of octogenarian patients undergoing uncemented total hip arthroplasty (THA) with a control group of similarly aged patients undergoing hybrid THA with a minimum 5-year follow-up.Methods
Clinical outcomes including intraoperative and postoperative complications, blood transfusion, revision rate, and mortality were recorded. Radiological analysis of preoperative and postoperative radiographs assessed bone quality, implant fixation, and any subsequent loosening.Results
One hundred forty-three patients (mean age 86.2 years) were enrolled in the study. Seventy-six patients underwent uncemented THA and 67 underwent hybrid THA. The uncemented cohort had a significantly lower intraoperative complication rate (P = .017) and also a lower transfusion rate (P = .002). Mean hospital stay (P = .27) was comparable between the 2 groups. Two patients underwent revision surgery in each cohort.Conclusion
Our study demonstrates that uncemented THA is safe for the octogenarian patient and we recommend that age should not be a barrier to the choice of implant. However, intraoperative assessment of bone quality should guide surgeons to the optimum decision regarding uncemented and hybrid implants.Level of evidence
3. 相似文献20.
Emre Gorgun Ipek Sapci Akin Onder Gokhan Ozuner David Liska Luca Stocchi Conor P. Delaney 《American journal of surgery》2018,215(1):62-65