共查询到20条相似文献，搜索用时 31 毫秒
1.
Angelena Crown Nicketti Handy Flavio G. Rocha Janie W. Grumley 《American journal of surgery》2018,215(5):910-915
INTRODUCTION
Oncoplastic breast conserving surgery (BCS) can enhance both cosmetic and oncologic breast cancer outcomes. This study evaluates the outcomes and complications associated with oncoplastic reduction mammaplasty performed by surgical breast oncologists.METHODS
A single institution retrospective chart review of patients undergoing oncoplastic reduction mammaplasty by a surgical breast oncologist for the treatment of breast cancer.RESULTS
Seventy-one patients were identified. The average patient age was 59.6 years (range 37–77 years). Average lesion span was 31.4?mm (range 3–166?mm). Six (8.5%) patients required additional surgery to obtain adequate margins. One (1.4%) patient developed recurrent disease during the follow-up interval. No major surgical complications were observed.CONCLUSION
Oncoplastic reduction mammaplasty is associated with low rates of re-excision and complications and can be safely and effectively performed by appropriately trained surgical breast oncologists. 相似文献2.
Stephanie A. Valente Yitian Liu Siddhi Upadhyaya Chao Tu Debra A. Pratt 《American journal of surgery》2019,217(3):514-518
Introduction
The aim of this study was to determine whether complications following mastectomy with immediate breast reconstruction (IBR) were associated with breast cancer recurrence.Methods
A retrospective review was performed of women diagnosed with stage I-III breast cancer who underwent mastectomy with IBR between 2005 and 2010. Patient demographics, tumor data, surgical wound complications, treatment details and timing were recorded and analyzed.Results
We identified 458 women with a median follow up time of 7.6 years. A total of 22% of patients experienced IBR complications. There was a delay in initiation of adjuvant therapy in patients who had a complication (52 vs 41 days, p?<?0.001). There was no significant difference in recurrences between groups with and without complications (p?=?0.65).Conclusions
In breast cancer patients who undergo mastectomy with IBR, wound complications delayed initiation of adjuvant systemic therapy, but were not associated with an increased risk of cancer recurrence. 相似文献3.
Erica Burkheimer Leah Starks Mariam Khan Leon Oostendorp Marianne K. Melnik Mathew H. Chung G. Paul Wright 《American journal of surgery》2019,217(3):474-477
Introduction
Obesity has been associated with negative oncologic outcomes in breast cancer.Methods
Retrospective review of patients with operable breast cancer at a single institution from 2009 to 2012. Patients with carcinoma in situ or metastatic disease were excluded. Variables included utilization of MRI, surgical treatment, perioperative, and long-term oncologic outcomes. Primary outcome was rate of breast conserving surgery. Secondary outcomes included MRI utilization, contralateral prophylactic mastectomy, and perioperative outcomes.Results
There were 1566 patients included for the study, 596 (38%) of whom were obese. MRI was utilized less in obese patients (62.4% vs 51.2%, p?<?0.001). Breast conserving surgery was more common in obese patients (53.1% vs 59.7%, p 0.010). There was no difference in performance of contralateral prophylactic mastectomy or post-mastectomy reconstruction. Perioperative outcomes were inferior in obese patients including increased surgical site infections (5.7% vs 11.7%, p?<?0.001), return to the emergency department (2.5% vs 5.2%, p 0.004), and hospital readmissions (1.8% vs 3.7%, p 0.017). No difference in survival was observed.Conclusion
Obese patients with operable breast cancer receive different treatment than non-obese patients, however survival and recurrence outcomes were similar among the two groups. 相似文献4.
Aim
To compare the value of Procalcitonin (PCT) as a marker of surgical site infection to other inflammatory markers, including C-Reactive Protein (CRP), White Cell Count (WCC) and Erythrocyte Sedimentation Rate (ESR) in patients undergoing a number of spinal procedures. This study also aims to describe the biokinetic profile of the above-named markers in patients developing surgical site infection and those remaining infection-free post-operatively.Methods
200 patients undergoing four routine elective spinal procedures were included for analysis. All patients had blood specimens taken at baseline, day 1, 2, 3, 4 and 5 post-operatively for analysis of PCT, CRP, ESR and WCC levels. All patients were monitored for early surgical site infection. Patients with other sources of infection in the early postoperative period were excluded.Results
Procalcitonin was the most sensitive and specific marker for the detection of surgical site infection in the immediate post-operative period with sensitivity and specificity of 100% and 95.2% respectively. Although Procalcitonin is an inflammatory marker, extent of surgical physiological insult did not alter its biokinetics as opposed to the other inflammatory markers making it a valuable marker of infection.Conclusion
Procalcitonin was found to be superior to the other inflammatory markers investigated in this study as a marker for early surgical site infection in patients undergoing spinal surgery. 相似文献5.
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6.
Mahmoud Farag Kareem Ibraheem Meghan E. Garstka Hosam Shalaby Christopher DuCoin Mary Killackey Emad Kandil 《American journal of surgery》2019,217(1):142-145
Introduction
Obesity is associated with numerous complications after elective general surgeries. The aim is to compare surgical outcomes and local specific complications in obese and non-obese patients after thyroid surgery.Methods
Retrospective study over a 3-year period at a North American academic institution. Outcome measures were operative time, estimated blood loss, hospital length of stay, and local specific complications (hypocalcemia, recurrent laryngeal nerve injury, wound hematoma, wound seroma, and chyle leakage).Results
A total of 469 patients were included (mean [SD] age, 50.11 [15.01] years; mean [SD] BMI, 30.5 [8.3] kg/m2; 207 [44.14%] obese). There was no difference in operative time (125.7 vs. 129.6, p?=?0.52), estimated blood loss (16.88 vs. 14.56, p?=?0.28), or hospital length of stay (0.95 vs. 0.95, p?=?0.96). Overall, there was no difference in the rates of local specific complications between the two groups.Conclusions
Obesity is not associated with adverse outcomes in patients undergoing thyroid surgery. 相似文献7.
A. Torborg L. Cronje J. Thomas H. Meyer A. Bhettay J. Diedericks C. Cilliers H. Kluyts B. Mrara M. Kalipa R. Rodseth B. Biccard 《British journal of anaesthesia》2019,122(2):224-232
Background
Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs).Methods
We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications.Results
We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4–11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2–8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6–1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery.Conclusions
The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs.8.
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9.
Felice De Stefano Catherine R. Garcia Meera Gupta Francesc Marti Lilia Turcios Adam Dugan Roberto Gedaly 《American journal of surgery》2019,217(4):664-669
Background/Aim
We aim to study the impact of PH in patients undergoing gastrointestinal surgery (GI).Methods
We queried the ACS-NSQIP database from 2005 through 2010 for patients undergoing GI surgery with PH. Esophageal varices (EV) diagnosis was used as a surrogate of PH.Results
A total of 192,296 patients underwent GI surgery, of which 379 had PH. Regression analyses revealed that patients with PH had a 6-fold (95% CI 4.6–7.9) increase in 30-day mortality, a 3-fold (95% CI 2.5–3.7) increase in morbidity, a 3.2-fold (95% CI 2.6–3.9) increase in critical care complications (CCC), and a 6.5-day (95% CI 5.1–7.8) increase in hospital LOS. After PSM, the impact of PH on the outcomes remained. These differences were significant regardless of the emergent or elective status of the procedure. AUC analysis demonstrated that MELD and MELDNa + score greater than 10.5 was the most predictive of peri-operative mortality in elective PH cases.Conclusions
PH is associated with an increased risk of poor surgical outcomes in patients undergoing elective and emergent gastrointestinal surgery. 相似文献10.
R. Eljaiek Y.A. Cavayas E. Rodrigue G. Desjardins Y. Lamarche F. Toupin A.Y. Denault W. Beaubien-Souligny 《British journal of anaesthesia》2019,122(2):206-214
Background
Right ventricular failure after cardiac surgery is associated with morbidity and mortality. Right ventricular dysfunction results in hepatic venous congestion, which impacts the portal circulation. We aimed to determine whether an increased portal flow pulsatility fraction was associated with right ventricular dysfunction in cardiac surgery patients. We also aimed to describe the haemodynamic factors and postoperative complications associated with an increased portal pulsatility in this setting.Methods
We conducted a prospective single-centre cohort study, recruiting adults undergoing cardiac surgery. Portal flow was assessed before, during, and after surgery by Doppler ultrasound. A detailed haemodynamic and echocardiographic assessment was performed at the same time points.Results
A total of 115 patients were included. Both systolic and diastolic right ventricular dysfunction were associated with a higher portal pulsatility fraction (P=0.008 and <0.001, respectively). A positive association was present between portal pulsatility fraction and measurements representative of venous pressure (central venous pressure, inferior vena cava diameter). A post-procedural portal pulsatility fraction ≥50% measured in the operating room was present in 21 (18.3%) patients and was associated with an increased risk of major complications (odds ratio=5.83, confidence interval, 2.04–16.68, P=0.001). The addition of portal flow assessment to a predictive model including EuroSCORE II and systolic right ventricular dysfunction improved prediction of postoperative complications.Conclusions
High portal flow pulsatility fraction is associated with right ventricular dysfunction, signs of venous congestion and decreased perfusion, and an increased risk of major complications. Portal vein Doppler ultrasound appears to be promising for risk assessment in the perioperative period.Clinical trials registration
NCT02658006. 相似文献11.
Sophia A. Traven Russell A. Reeves Molly G. Sekar Harris S. Slone Zeke J. Walton 《The Journal of arthroplasty》2019,34(1):140-144
Background
While the 11-factor modified frailty index (mFI) has been shown to predict adverse outcomes in patients undergoing total joint arthroplasty, the 5-factor index has not been evaluated in this patient population. The goal of this study was to evaluate the utility of the mFI-5 as a predictor of morbidity and mortality in patients undergoing primary total hip and knee arthroplasty.Methods
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program's database for patients undergoing total hip arthroplasty and total knee arthroplasty between the years 2005 and 2016 was conducted. The 5-factor score, which includes the presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications while controlling for demographic variables.Results
One hundred forty thousand one hundred fifty-eight patients undergoing total hip arthroplasty and 226,398 patients undergoing total knee arthroplasty were identified. After adjusting for demographic variables and comorbid conditions, logistic regression analyses revealed that the mFI-5 was a strong predictor for total complications, Clavien-Dindo grade IV complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), surgical site infections, readmission, and 30-day mortality (P < .001).Conclusions
The mFI-5 is an independent predictor of postoperative complications including life-threatening medical complications, surgical site infections, hospital readmission, and 30-day mortality after primary hip and knee arthroplasty. This clinical tool can be used to identify high-risk surgical patients and guide preoperative counseling to optimize outcomes.Level of Evidence
III. 相似文献12.
Byron D. Hughes Eric Sieloff Hemalkumar B. Mehta Anthony J. Senagore 《American journal of surgery》2019,217(3):534-538
Background
In 2008, 2005–2006 National Surgical Quality Improvement Program (NSQIP) data were used to identify surgical operations contributing disproportionately to morbidity and mortality. Since then, numerous enhanced recovery programs have been utilized to augment quality improvement efforts. This study reassesses procedural complication incidence after a decade of quality improvement efforts.Methods
Data from the 2015 NSQIP were used. The same original 36 general surgery procedure groups were created using Current Procedural Terminology codes. Ninety percent of our 409,230 patients matched into a procedure group and adverse event rates were analyzed for each.Results
Ten procedure groups accounted for 80% of adverse events. Colectomy ranked the highest for adverse events (34%), readmissions (27%) and mortality rates (45.8%). For outpatient cholecystectomy, the relative percent point difference for adverse events has increased by 224% since 2005.Conclusion
Refocusing on colectomy and outpatient cholecystectomy represent current priorities in general surgery. 相似文献13.
Hirohisa Okabe Takayuki Ohsaki Katsuhiro Ogawa Nobuyuki Ozaki Hiromitsu Hayashi Shinichi Akahoshi Yoshiaki Ikuta Kenichi Ogata Hideo Baba Hiroshi Takamori 《American journal of surgery》2019,217(4):677-681
Background
We aim to clarify if frailty affects severe postoperative complications in elective colorectal surgery.Methods
Consecutive 269 colorectal cancer patients older than 65 years undergoing curative surgery were enrolled in this study. The relevance of the frailty and sarcopenia to postoperative outcome was assessed. Clinical frailty (CF) was defined as clinical frailty scale (CFS)?≥?4. Sarcopenia was assessed by measuring skeletal muscle area using computed tomography.Results
Seventy-eight patients (29%) had CF and 159 patients (59%) had sarcopenia. CF was significantly associated with older age (P?=?0.0008), postoperative severe complications (P?=?0.001), and postoperative in-hospital stay (P?<?0.0001), although sarcopenia was not. Logistic regression analysis revealed that low anterior resection and CF were independent predictors of severe postoperative complications (P?=?0.038 and P?=?0.001, respectively).Conclusion
CF, but not sarcopenia, is a robust predictor of severe postoperative complications in patients with colorectal cancer. 相似文献14.
Amanda Kupstas Warda Ibrar R. David Hayward David Ockner Cheryl Wesen Jeffrey Falk 《American journal of surgery》2018,215(3):400-403
Background
A single center retrospective chart review was performed examining the ability of a novel radiofrequency probe (Margin Probe; Dune Medical Devices, Caesarea, Israel) for intraoperative margin assessment to reduce the number of reexcisions in breast-conserving surgery.Methods
Reexcision rates were evaluated in one-hundred and twenty consecutive patients before and after the institution of the device. Utility of the device was evaluated by comparing intraoperative feedback with postoperative pathology reports.Results
Two hundred and forty patient subjects were reviewed in total. There was a significant decrease in the re-lumpectomy rate (50%, p = 0.039) in the device group without increasing the total volume of tissue resected.Conclusions
The use of the MarginProbe device as an adjunct to the standard of care resulted in reduction of positive margins after lumpectomy and the number of re-excisions, significantly improving outcomes in breast-conserving surgery at our institution. 相似文献15.
Cynthia M. Tom James D. Maciel Abraham Korn Junko J. Ozao-Choy Danielle M. Hari Angela L. Neville Christian de Virgilio Christine Dauphine 《American journal of surgery》2019,217(2):256-260
Background
Robotic surgery is increasingly adopted into surgical practice, but it remains unclear what level of robotic training general surgery residents receive. The purpose of our study was to assess the variation in robotic surgery training amongst general surgery residency programs in the United States.Methods
A web-based survey was sent to 277 general surgery residency programs to determine characteristics of resident experience and training in robotic surgery.Results
A total of 114 (41%) programs responded. 92% (n?=?105) have residents participating in robotic surgeries; 68%(n?=?71) of which have a robotics curriculum, 44%(n?=?46) track residents’ robotic experience, and 55%(n?=?58) offer formal recognition of training completion. Responses from university-affiliated (n?=?83) and independent (n?=?31) programs were not significantly different.Conclusions
Many general surgery residencies offer robotic surgery experience, but vary widely in requisite components, formal credentialing, and case tracking. There is a need to adopt a standardized training curriculum and document resident competency. 相似文献16.
Yeqian Huang Nayef A. Alzahrani Oliver M. Fisher Terence C. Chua Mathew A. Kozman Winston Liauw Arief Arrowaili Sarah J. Valle David L. Morris 《American journal of surgery》2019,217(4):704-712
Background
This study examines the impact of intraoperative macroscopic tumour consistency on short-term and long-term outcomes after cytoreductive surgery (CRS) with intraperitoneal chemotherapy (IPC) for appendiceal adenocarcinoma with peritoneal metastases.Methods
Macroscopic intraoperative tumour consistency was classified in three groups as soft (jelly-like geltatinous tumours), hard (hard tumour nodules without gelatinous features) and intermediate (both soft and hard features). In-hospital mortality, major morbidity, intensive care unit (ICU), high dependency unit (HDU) and total hospital stay, disease-free survival (DFS) and overall survival (OS) were compared.Results
The three groups had similar perioperative short-term outcomes. Patients with soft, intermediate and hard tumours revealed differences in OS (p?<?0.001) and DFS (p?=?0.03). Multivariable analysis revealed a shorter OS for patients with hard versus soft tumours (HR for hard tumours?=?4.43, 95%CI 2.19–9.00).Conclusions
Intraoperative macroscopic tumour consistency may be used as a prognostic marker for survival in patients with appendiceal adenocarcinoma with peritoneal metastases. 相似文献17.
Vikas Satyananda Junko Ozao-Choy Christine Dauphine Kathryn T. Chen 《American journal of surgery》2019,217(4):764-766
Introduction
The Affordable Care Act (ACA) mandated the expansion of Medicaid in order to increase access to health care services. We examined the effect of the ACA on breast cancer screening and diagnosis at a Los Angeles safety net hospital.Methods
We performed a retrospective review of breast cancer patients treated at our institution. We compared two cohorts: patients diagnosed with breast cancer in the years 2011–2012 (pre-ACA) vs. 2015–2016 (post-ACA).Results
There were no differences in number of screening mammograms performed, age at diagnosis, mammography-detected cancers, or clinical stage at diagnosis. There was a significant decrease in the number of patients who reported as self-pay (34% vs. 6%, p?<?0.0001).Conclusion
In the 2-year period following ACA implementation, there was limited impact on breast cancer presentation at a safety-net hospital. Long-term follow-up across different healthcare systems is necessary to fully evaluate the global impact of the ACA on breast cancer care. 相似文献18.
George E. Fowler Pei Ru Chew C.B.B. Lim Sabapathy P. Balasubramanian 《The surgeon》2019,17(2):102-106
Introduction
Recurrent laryngeal nerve (RLN) palsy is a potential complication of parathyroid surgery with significant morbidity and a cause of medico-legal litigation. Peri-operative laryngoscopy to assess RLN function helps identify a vocal cord palsy and guide management. The value of its routine use in asymptomatic patients is however unclear. The low risk of permanent palsy, rarity of true asymptomatic palsy and costs, discomfort and inconvenience to patients are arguments against routine laryngoscopy. This study assessed the results of routine laryngoscopy in patients having parathyroid surgery for primary hyperparathyroidism (PHPT).Methods
All patients having parathyroid surgery for PHPT (exclusion: re-do surgery and concurrent thyroidectomy) over a 3-year period were included from a tertiary endocrine surgical unit. Data on voice-related outcomes and pre- and post-operative laryngoscopy, including its local cost, were collected and analysed.Results
Of 189 patients who underwent parathyroid surgery, 66 had a unilateral neck exploration. The incidence of vocal cord palsy was 0.5% (1 in 186 patients) and 1.7% (3 in 179 patients) for pre- and post-operative laryngoscopy respectively. The single patient with pre-operative cord palsy was asymptomatic. Of the three with post-operative cord palsy, two were temporary and symptomatic and one was asymptomatic. In the region, the clinical commissioning group was charged £127.00 per laryngoscopy, amounting to £46,736.00 for the whole cohort.Conclusions
The rare nature of vocal cord palsy suggests laryngoscopy is not necessary for patients having surgery for PHPT. It may be reserved for patients with voice change and those having re-operative or concomitant thyroid surgery. 相似文献19.
Monica M. Betancourt-Garcia Kristina Vatcheva Prateek K. Gupta Ricardo D. Martinez Joseph B. McCormick Susan P. Fisher-Hoch R. Armour Forse 《American journal of surgery》2019,217(4):618-633
Background
Existing literature has shown racial/ethnic disparities between white and black surgical populations, however, surgical outcomes for Hispanic patients are limited in both scope and quantity.Methods
Data from the American College of Surgeons National Surgical Quality Improvement Program from 2007 to 2015 was used to analyze surgical outcomes in approximately 3.5 million patients.Results
Overall, Hispanics experienced lower odds of mortality compared to non-Hispanic White, non-Hispanic Black, and non-Hispanic American Indian or Alaska Native patients (all P?<?0.0001). No difference was found in mortality odds between Hispanics and non-Hispanic Asian or Native Hawaiian patients. Hispanics experienced minimal disparities in complications as compared to non-Hispanic White and non-Hispanic Black but had a higher rate of select complications when compared to Non-Hispanic Asian, Native Hawaiian, or Pacific Islander.Conclusion
Hispanics, in general, had lower odds of 30-day postoperative mortality and major morbidity compared to most of the races/ethnicities included in the ACS NSQIP database. 相似文献20.
Miju Bae Sung Woon Chung Chung Won Lee Up Huh Min Su Kim Seung Hwan Song 《Asian journal of surgery / Asian Surgical Association》2019,42(1):235-239