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the association of perioperative practice

Jevon R Puckett, John W Pickering, Suetonia C Palmer, John L McCall, Michal T Kluger, Janak De Zoysa, Zoltan H Endre, Mattias Soop
OBJECTIVE: To determine whether a low perioperative minimum urine output target is safe and fluid sparing when compared with the standard target. BACKGROUND: A minimum hourly urine output of 0.5 mL/kg is a key target guiding perioperative fluid therapy. Few data support this standard practice, which may contribute to perioperative fluid overloading. METHODS: We randomized patients without significant risk factors for acute kidney injury undergoing elective colectomy to a minimum urine output target of 0...
October 19, 2016: Annals of Surgery
Poonam Malhotra Kapoor, Kanchi Muralidhar, Navin C Nanda, Yatin Mehta, Naman Shastry, Kalpana Irpachi, Aditya Baloria
In 1980, Transesophageal Echocardiography (TEE) first technology has introduced the standard of practice for most cardiac operating rooms to facilitate surgical decision making. Transoesophageal echocardiography as a diagnostic tool is now an integral part of intraoperative monitoring practice of cardiac anaesthesiology. Practice guidelines for perioperative transesophageal echocardiography are systematically developed recommendations that assist in the management of surgical patients, were developed by Indian Association of Cardiac Anaesthesiologists (IACTA)...
October 2016: Annals of Cardiac Anaesthesia
Jason M Davies, Michael T Lawton
OBJECTIVE Treatment of cerebrovascular malformations has grown in complexity with the development of multimodal approaches, including microsurgery, endovascular treatments, and radiosurgery. In spite of this changing standard of care, the provision of care continues across a variety of settings. The authors sought to determine the risk of adverse outcome after treatment of patients with vascular malformations in the US. Patient, surgeon, and hospital characteristics, including volume, were tested as potential outcome predictors...
October 14, 2016: Journal of Neurosurgery
Pierre-Antoine Moulin, Anne Dutour, Patricia Ancel, Pierre-Emmanuel Morange, Thierry Bege, Olivier Ziegler, Stéphane Berdah, Corinne Frère, Bénédicte Gaborit
BACKGROUND: Venous thromboembolism (VTE) is a leading cause of death in obese patients undergoing bariatric surgery (BS), but there is neither consensus nor high-level guidelines yet on VTE prophylaxis in this specific population. OBJECTIVE: We aimed to evaluate patterns of BS perioperative thromboprophylaxis practices. SETTING: French obesity specialized care centers (CSO), which are tertiary care referral hospitals for the most severe cases of obesity METHODS: A detailed questionnaire survey (11 opened, 15 closed questions) investigating their prophylactic schemes of anticoagulation (molecule, dose, weight-adjustment, duration, associated measures, follow-up) was sent to the 37 CSO...
September 1, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Deepak Prakash Borde, Antony George, Shreedhar Joshi, Suresh Nair, Thomas Koshy, Uday Gandhe, Murali Chakravarthy
CONTEXT: Use of perioperative transesophageal echocardiography (TEE) has expanded in India. Despite attempts to standardize the practice of TEE in cardiac surgical procedures, variation in practice and application exists. This is the first online survey by Indian College of Cardiac Anaesthesia, research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists (IACTA). AIMS: We hypothesized that variations in practice of intraoperative TEE exist among centers and this survey aimed at analyzing them...
October 2016: Annals of Cardiac Anaesthesia
S S Bahia, A Vidal-Diez, S R K Seshasai, I Shpitser, J R Brownrigg, B O Patterson, K K Ray, P J Holt, M M Thompson, A Karthikesalingam
BACKGROUND: Perioperative mortality is low for patients undergoing abdominal aortic aneurysm (AAA) repair, but long-term survival remains poor. Although patients diagnosed with AAA have a significant burden of cardiovascular disease and associated risk factors, there is limited understanding of the contribution of cardiovascular risk management to long-term survival. METHODS: General practice records within The Health Improvement Network (THIN) were examined. Patients with a diagnosis of AAA and at least 1 year of registered medical history were identified from 2000 to 2012...
October 5, 2016: British Journal of Surgery
Gaya Spolverato, Fabio Bagante, Matthew Weiss, Jin He, Christopher L Wolfgang, Fabian Johnston, Martin A Makary, Will Yang, Steven M Frank, Timothy M Pawlik
BACKGROUND: Delta hemoglobin (ΔHb) is defined as the difference between the preoperative Hb and the lowest post-operative Hb level. We sought to define the impact of ΔHb relative to nadir Hb levels on the likelihood of transfusion, as well as characterize the impact of ΔHb and nadir Hb on morbidity among a large cohort of patients undergoing complex hepatopancreatobiliary (HPB) surgery. METHODS: Patients who underwent pancreatic or hepatic resection between January 1, 2009 and June 30, 2015 at Johns Hopkins Hospital were identified...
September 30, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Helen Kaganov, Alex Ades
BACKGROUND: Uterine leiomyomas, or fibroids, represent a large proportion of gynaecological presentations in both general and specialist gynaecology practice. The diagnosis is relatively simple with current imaging modalities. The management of fibroids, however, is not always straightforward and can present many challenges. OBJECTIVE: This article reviews current approaches to the management of uterine fibroids, including novel techniques, and highlights important patient counselling points...
October 2016: Australian Family Physician
Omar H Ahmed, Sonya Marcus, Jenna R Tauber, Binhuan Wang, Yixin Fang, Richard A Lebowitz
OBJECTIVE: Perioperative lumbar drain (LD) use in the setting of endoscopic cerebrospinal fluid (CSF) leak repair is a well-established practice. However, recent data suggest that LDs may not provide significant benefit and may thus confer unnecessary risk. To examine this, we conducted a meta-analysis to investigate the effect of LDs on postoperative CSF leak recurrence following endoscopic repair of CSF rhinorrhea. DATA SOURCES: A comprehensive search was performed with the following databases: Ovid MEDLINE (1947 to November 2015), EMBASE (1974 to November 2015), Cochrane Review, and PubMed (1990 to November 2015)...
September 27, 2016: Otolaryngology—Head and Neck Surgery
Alexi A Wright, Kari Bohlke, Deborah K Armstrong, Michael A Bookman, William A Cliby, Robert L Coleman, Don S Dizon, Joseph J Kash, Larissa A Meyer, Kathleen N Moore, Alexander B Olawaiye, Jessica Oldham, Ritu Salani, Dee Sparacio, William P Tew, Ignace Vergote, Mitchell I Edelson
PURPOSE: To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. METHODS: The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. RESULTS: Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality...
October 2016: Gynecologic Oncology
Denis Querleu, François Planchamp, Luis Chiva, Christina Fotopoulou, Desmond Barton, David Cibula, Giovanni Aletti, Silvestro Carinelli, Carien Creutzberg, Ben Davidson, Philip Harter, Lene Lundvall, Christian Marth, Philippe Morice, Arash Rafii, Isabelle Ray-Coquard, Andrea Rockall, Cristiana Sessa, Ate van der Zee, Ignace Vergote, Andreas du Bois
OBJECTIVES: The surgical management of advanced ovarian cancer involves complex surgery. Implementation of a quality management program has a major impact on survival. The goal of this work was to develop a list of quality indicators (QIs) for advanced ovarian cancer surgery that can be used to audit and improve the clinical practice. This task has been carried out under the auspices of the European Society of Gynaecologic Oncology (ESGO). METHODS: Quality indicators were based on scientific evidence and/or expert consensus...
September 2016: International Journal of Gynecological Cancer
Rachel Moses, Deepak Agarwal, Eric Raffin, Boyd Viers, Vidit Sharma, Amy Krambeck, Vernon Pais
OBJECTIVES: To investigate the incidence of Systemic Inflammatory Response Syndrome (SIRS) following Percutaneous Nephrolithotomy (PCNL ) and evaluate any association with unplanned 90 day readmission. METHODS: We retrospectively reviewed consecutive patients undergoing PCNL in two dedicated endourologic practices between 2009 and 2013. We collected patient demographics, perioperative culture data, and operative characteristics. SIRS was defined as having two or more of the following: maximum white blood cell count >12,000 or <4,000, temperature>38or<34 degrees Celsius, heart rate >90, and respiratory rate >20 within the first 24hrs following PCNL...
September 15, 2016: Urology
Claudia Villanueva, Mathew Doyle, Jessica Berger, Gary Fermanis, Derek Glenn
Massive mediastinal tumours are rare in clinical practice and complete surgical resection may be associated with serious complications. Preoperative angiography and embolisation are valuable adjuncts in the management of giant tumours to decrease perioperative blood loss, provide a clear operative field and facilitate complete resection. We report the safe use of preoperative embolisation which facilitated excision via clamshell incision, of a highly vascular massive anterior mediastinal tumour with an unusual final diagnosis...
August 30, 2016: Heart, Lung & Circulation
C Alboim, R B Kliemann, L E Soares, M M Ferreira, C A Polanczyk, A Biolo
PurposeAmbulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery.MethodsThis was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records...
September 16, 2016: Eye
Christopher T Aquina, Neil Blumberg, Adan Z Becerra, Francis P Boscoe, Maria J Schymura, Katia Noyes, John R T Monson, Fergal J Fleming
OBJECTIVE: To investigate the potential additive effects of blood transfusion and sepsis on colon cancer disease-specific survival, cardiovascular disease-specific survival, and overall survival after colon cancer surgery. BACKGROUND: Perioperative blood transfusions are associated with infectious complications and increased risk of cancer recurrence through systemic inflammatory effects. Furthermore, recent studies have suggested an association among sepsis, subsequent systemic inflammation, and adverse cardiovascular outcomes...
September 14, 2016: Annals of Surgery
Florence Mary, Aziz Zaanan, Valérie Boige, Pascal Artru, Emmanuelle Samalin, Romain Coriat, Jean-Baptiste Bachet, Marouane Boubaya, Mourad Benallaoua, David Tougeron, Pauline Afchain, Christophe Locher, Isabelle Baumgaertner, Cédric Lecaille, Gaetan des Guetz, Thomas Aparicio
PURPOSE: Perioperative chemotherapy with 5-fluorouracil and cisplatin, with or without epirubicin, improves overall survival in resectable gastroesophageal junction and gastric adenocarcinoma. The aim of this retrospective multicenter study was to evaluate the safety and efficacy of perioperative chemotherapy with a FOLFOX-based regimen. PATIENTS AND METHODS: We enrolled patients with resectable gastric or gastroesophageal adenocarcinoma, who had at least 3 cycles of a pre-operative FOLFOX-based regimen...
August 9, 2016: Digestive and Liver Disease
Antonio Graham, Charles H Brown
Older adults make up an ever-increasing number of patients presenting for surgery, and a significant percentage of these patients will be frail. Frailty is a geriatric syndrome that has been conceptualized as decreased reserve when confronted with stressors, although the precise definition of frailty has not been easy to standardize. The 2 most popular approaches to define frailty are the phenotypic approach and the deficit accumulation approach, although at least 20 tools have been developed, which has made comparison across studies difficult...
September 12, 2016: Anesthesia and Analgesia
Kyle Sheetz, Mark R Hemmila, Ashley Duby, Greta Krapohl, Arden Morris, Darrell A Campbell, Samantha Hendren
BACKGROUND: Emergency general surgery is associated with high morbidity and mortality but has seldom been targeted for practice improvement. The goal of this study was to determine whether perioperative practices vary among surgeons for emergency Hartmann's procedures and whether perioperative care practices are associated with hospitals' complication rates. MATERIALS AND METHODS: We conducted a survey of surgeons at 27 Michigan hospitals. Questionnaires focused on preoperative, intraoperative, and postoperative care practices...
September 2016: Journal of Surgical Research
Emily Benham, William Richardson, Jonathan Dort, Henry Lin, A Michael Tummers, Travelyan M Walker, Dimitrios Stefanidis
BACKGROUND: Surgical safety checklists reduce perioperative complications and mortality. Given that minimally invasive surgery (MIS) is dependent on technology and vulnerable to equipment failure, SAGES and AORN partnered to create a MIS checklist to optimize case flow and minimize errors. The aim of this project was to evaluate the effectiveness of the SAGES/AORN checklist in preventing disruptions and determine its ease of use. METHODS: The checklist was implemented across four institutions and completed by the operating team...
September 7, 2016: Surgical Endoscopy
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