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Patient Safety in Surgery

Boris A Zelle, Antonio J Webb, Christopher Matson, Michael Morwood, Khang H Dang, Samuel S Ornell, Gabrielle Gostigian, Cody M Ramirez, Hassan Mir
Introduction: Recent advances have led to the design of a new cephalomedullary nail, which aims to decrease the risk of failures in patients with intertrochanteric hip fractures by allowing for insertion of two interdigitating screws into the head segment. The goal of this study is to evaluate the safety and efficacy of this two-screw cephalomedullary nailing system. Patients/participants: Patients 18 years of age and older who underwent intramedullary nailing of their intertrochanteric femoral fracture using the InterTAN nailing system (Smith and Nephew, Memphis, TN) from 2012 to 2016 were included in this retrospective study which was performed at two urban certified level-1 trauma centers and one urban certified level-3 trauma center...
2018: Patient Safety in Surgery
Robert S O'Connell, Bryce N Clinger, Erin E Donahue, Francesco S Celi, Gregory J Golladay
Background: Dexamethasone has been routinely used in the pre-operative setting to enhance analgesia and decrease the incidence of nausea and vomiting in patients undergoing primary arthroplasty. However, dexamethasone has the potential to increase blood glucose levels postoperatively, which is a known risk factor for complications after total joint arthroplasty. The aim of this study was to analyze the effect of dexamethasone administration on post-operative blood glucose levels in diabetic patients after primary hip and knee arthroplasty...
2018: Patient Safety in Surgery
Nabil Alassaf
Background: Open reduction of the congenitally dislocated hip may not be possible without femoral shortening. The goal of this study is to develop a prognostic prediction model for the need of femoral shortening in children undergoing anterior open reduction for the treatment of developmental dysplasia of the hip (DDH). The secondary objective was to determine if femoral shortening influences the risk of adverse events. Methods: A cohort from February 1, 2008 thru July 31, 2017 was studied retrospectively at a single centre...
2018: Patient Safety in Surgery
Abdulrahman Hamad Al-Abdulwahhab, Abdulaziz Mohammad Al-Sharydah, Sari Saleh Al-Suhibani, Saeed Ahmad Al-Jubran, Ali Khalaf Al-Haidey, Abdulkhaliq Ibrahim Al-Hifzi, Wissam Al-Issawi
Background: Spinal myelitis is an infrequent manifestation of spinal cord infection. It is caused by the Schistosoma species, which are endemic in South America, part of the Middle East, and Africa. Case presentation: We report the case of a 13-year-old male adolescent complaining of progressive lower back pain and weakness of the lower extremities for 3 days. Initial magnetic resonance imaging revealed typical transverse myelitis. Subsequently, parasite serology showed a markedly elevated level of Schistosoma antibody titers, and cerebrospinal fluid analysis yielded normal results...
2018: Patient Safety in Surgery
Ala A Alhowary, Haitham Odat, Obada Alali, Ali Al-Omari
Background: Angiotensin II receptor blockers are a class of antihypertensive agent that is developed to exclude the adverse effects of angiotensin converting enzyme inhibitors. However, as angiotensin II receptor blockers have begun to be more widely prescribed, cases of angiotensin II receptor blocker-induced angioedema have been reported. Rare cases of angioedema following surgery in patients using angiotensin converting enzyme inhibitors have been published. Case presentation: A 38-year-old man with past history of hypertension was admitted for an elective lumbosacral spine surgery...
2018: Patient Safety in Surgery
James T Carson, Sabin G Shah, Gezzer Ortega, Sorawut Thamyongkit, Erik A Hasenboehler, Babar Shafiq
Background: There have been no large-scale epidemiological studies of outcomes and perioperative complications in morbidly obese trauma patients who have sustained closed pelvic ring or acetabular fractures. We examined this population and compared their rate of inpatient complications with that of control patients. Methods: We retrospectively reviewed the records of patients treated for closed pelvic ring or acetabular fracture, aged 16-85 years, with Injury Severity Scores ≤15 from the National Trauma Data Bank Research Dataset for the years 2007 through 2010...
2018: Patient Safety in Surgery
Dimonge Joseph Anthony, Basnayaka Mudiyanselage Oshan Deshanjana Basnayake, Yasith Mathangasinghe, Ajith Peiris Malalasekera
Background: The marginal mandibular branch of the facial nerve is vulnerable to iatrogenic injuries during surgeries involving the submandibular region. This leads to significant post-operative morbidity. Studies assessing accurate anatomical landmarks of the marginal mandibular branch are sparse in South Asian countries. Present study was conducted to assess the relationship between the marginal mandibular branch and the inferior border of the body of mandible. Methods: Twenty-two preserved cadavers of Sri Lankan nationality were selected...
2018: Patient Safety in Surgery
Melaku Desta, Addissu Manaye, Abiot Tefera, Atalay Worku, Alemitu Wale, Alemlanchi Mebrat, Negesso Gobena
Background: Elective surgical case cancellation refers to any elective surgical case that is the list on the day prior to surgery but not operated upon as scheduled. Case cancellation has a major cause of psychological trauma to patients and their families. Despite little is known in Ethiopia. Therefore, this study aimed to assess incidence and reasons of cancellations of elective operation on the intended day of surgery at tertiary referral academic medical center in Ethiopia. Methods: A prospective hospital-based cross-sectional study design was conducted in a tertiary referral academic medical center in Ethiopia among 146 participants...
2018: Patient Safety in Surgery
Dimitra Daskalopoulou, Joseph Kankam, Jens Plambeck, Peter C Ambe, Konstantinos Zarras
Background: Bowel incarceration represents a dreaded complication amongst patients with hernias. The intraoperative evaluation of the bowel perfusion following hernia reduction with regard to the need for resection of ischaemic bowel can be challenging. In this case report we discuss intraoperative fluorescence angiography with indocyanine green (ICG) as an objective means of accessing bowel perfusion following hernia reduction. Case presentation: The case of a 92-year-old, caucasian, female patient presenting with symptoms of small bowel obstruction secondary to an incarcerated left sided obturator hernia is presented...
2018: Patient Safety in Surgery
Tushar Patial, Namit Rathore, Angesh Thakur, Digvijay Thakur, Kanika Sharma
Background: A retained surgical sponge remains a dreaded complication of modern surgery. Despite the increasing focus on patient safety instances of "a sponge being left in the abdomen", are all too common in popular media. In this article we report the rare phenomenon of transmigration of a retained surgical sponge in a patient who underwent laparoscopic sterilization. Case presentation: A 30-year-old female presented with progressive abdominal pain for about one month and vomiting with obstipation for 2 days...
2018: Patient Safety in Surgery
Mohammad Amre Fallaha, Sarkhell Radha, Sheena Patel
Background: Venous thromboembolism (VTE) remains a significant complication following knee and hip arthroplasty. National and international guidelines recommend pharmacological and mechanical thromboprophylaxis following surgery, unless contraindicated, to reduce the risk of VTE. This study aimed to explore the safety and efficacy profile of an adapted thromboprophylaxis regimen consisting of sequential enoxaparin and rivaroxaban for thromboprophylaxis following knee or hip arthroplasty at a London teaching hospital...
2018: Patient Safety in Surgery
Victoria M Steelman, Clarissa Shaw, Laurel Shine, Abbey J Hardy-Fairbanks
Background: Unintended retention of foreign bodies remain the most frequently reported sentinel events. Surgical sponges account for the majority of these retained items. The purpose of this study was to describe reports of unintentionally retained surgical sponges (RSS): the types of sponges, anatomic locations, accuracy of sponge counts, contributing factors, and harm, in order to make recommendations to improve perioperative safety. Methods: A retrospective review was undertaken of unintentionally RSS voluntarily reported to The Joint Commission Sentinel Event Database by healthcare facilities over a 5-year period (October 1, 2012- September 30, 2017)...
2018: Patient Safety in Surgery
Jonathan Chua, Arun Ratnavadivel
Background: The use of multiple infusions through one cannula is an increasingly common practice in anaesthesia. High pressures in the line often lead to occlusion alarms and pump disconnection. In this study, we aim to determine the pressures generated in common 3-way infusion devices, using simple low-cost equipment available and currently in use in the operating theatre environment. Methods: We compared three different common and commercially available 3-way infusion devices that allowed multiple infusions through one cannula in vitro...
2018: Patient Safety in Surgery
Dimonge Joseph Anthony, Basnayaka Mudiyanselage Oshan Deshanjana Basnayake, Nambunanayakkara Mahapalliyaguruge Gagana Ganga, Yasith Mathangasinghe, Ajith Peiris Malalasekera
Background: Accurate anatomical landmarks to locate the thoracodorsal nerve are important in axillary clearance surgery. Methods: Twenty axillary dissections were carried out on ten preserved Sri Lankan cadavers. Cadavers were positioned dorsal decubitus with upper limbs abducted to 900 . An incision was made in the upper part of the anterior axillary line. The lateral thoracic vein was identified and traced bi-directionally. The anatomical location of the thoracodorsal nerve was studied in relation to the lateral border of pectoralis minor and from a point along the lateral thoracic vein, 2 cm inferior to its confluence with the axillary vein...
2018: Patient Safety in Surgery
Matthew J Bradley, Angela T Kindvall, Ashley E Humphries, Elliot M Jessie, John S Oh, Debra M Malone, Jeffrey A Bailey, Philip W Perdue, Eric A Elster, Carlos J Rodriguez
Background: The Joint Trauma System has demonstrated improved outcomes through coordinated research and process improvement programs. With fewer combat trauma patients, our military American College of Surgeons level 2 trauma center's ability to maintain a strong trauma Process Improvement (PI) program has become difficult. As emergency general surgery (EGS) patients are similar to trauma patients, our Trauma and Acute Care Surgery (TACS) service developed an EGS PI program analogous to what is done in trauma...
2018: Patient Safety in Surgery
Kristin Salottolo, Laura Peck, Allen Tanner Ii, Matthew M Carrick, Robert Madayag, Emmett McGuire, David Bar-Or
Background: Widespread legislative efforts to legalize marijuana have increased the prevalence of marijuana use and abuse. The effects of marijuana on pain tolerance and analgesic pain management in the acute pain setting have not been reported. Although marijuana has been shown to have antinociceptive effects and is approved for medical use to treat chronic pain, anecdotal evidence suggests marijuana users admitted with traumatic injuries experience poorer pain control than patients who do not use marijuana...
2018: Patient Safety in Surgery
Juan Manuel Vinas-Rios, Martin Sanchez-Aguilar, Fatima Azucena Medina Govea, Viktor Von Beeg-Moreno, Frerk Meyer
Background: The recurrence rate in lumbar disc herniations (LDH) has been reported between 5 and 25%. There are only few data about this phenomenon that occurs within days of the initial operation. We analyse early recurrent LDH by analysis of data from the German Spine register. Methods: Data from patients undergoing disc herniation surgery in the lumbar region were extracted from the German Spine Registry between 1st January 2012 and 31st December 2016. Patients with early recurrent LDH within days of initial surgery were separately analysed...
2018: Patient Safety in Surgery
Sorawut Thamyongkit, Malick Bachabi, John M Thompson, Babar Shafiq, Erik A Hasenboehler
Background: The increasing financial burden of orthopaedic implants on our health care system has prompted cost-control measures, such as implant reprocessing. The purpose of this study was to describe the current usage by orthopaedic trauma surgeons of reprocessed external fixators (EFs) for treatment of complex fractures. Methods: A 16-question survey about use and perceptions of reprocessed EFs was distributed to 894 Orthopaedic Trauma Association members between August 2016 and June 2017 using a web-based survey system...
2018: Patient Safety in Surgery
Kristin Salottolo, Brian Cole, David Bar-Or
Background: There are limited efficacious treatment options for severe osteoarthritis of the knee (OAK). The Low Molecular Weight Fraction of 5% human serum Albumin (LMWF-5A) is in development to treat severe OAK. This study evaluated the safety and efficacy of LMWF-5A for the signs and symptoms of OAK. Methods: This 12-week randomized, double-blind, controlled clinical trial was conducted at thirteen sites across the United States. Patients with symptomatic, severe OAK (Kellgren-Lawrence grade 4 disease) who were fully ambulatory and had no other conditions interfering with the study knee were randomized to a single 4 ml intra-articular injection of LMWF-5A or saline, randomized 6:1...
2018: Patient Safety in Surgery
Naokazu Chiba, Kei Yokozuka, Shigeto Ochiai, Takahiro Gunji, Masaaki Okihara, Toru Sano, Koichi Tomita, Rina Tsutsui, Shigeyuki Kawachi
Background: The aim was to analyze hepatic hypertrophy after portal vein embolization (PVE) and Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) to determine whether clinical circumstances associated with major hepatic resections correlated with remnant growth. Methods: Data was abstracted from a retrospectively maintained database on 27 patients undergoing hepatic resection followed by PVE and the ALPPS procedure between October 1, 2007 and December 31, 2016...
2018: Patient Safety in Surgery
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