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Protocols to reduce risk in surgery

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https://www.readbyqxmd.com/read/28986337/improving-neuromuscular-monitoring-and-reducing-residual-neuromuscular-blockade-with-e-learning-protocol-for-the-multicenter-interrupted-time-series-invert-study
#1
Jakob Louis Demant Thomsen, Ole Mathiesen, Daniel Hägi-Pedersen, Lene Theil Skovgaard, Doris Østergaard, Jens Engbaek, Mona Ring Gätke
BACKGROUND: Muscle relaxants facilitate endotracheal intubation under general anesthesia and improve surgical conditions. Residual neuromuscular blockade occurs when the patient is still partially paralyzed when awakened after surgery. The condition is associated with subjective discomfort and an increased risk of respiratory complications. Use of an objective neuromuscular monitoring device may prevent residual block. Despite this, many anesthetists refrain from using the device. Efforts to increase the use of objective monitoring are time consuming and require the presence of expert personnel...
October 6, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28982834/how-biomarkers-reflect-the-prognosis-and-treatment-of-necrotising-soft-tissue-infections-and-the-effects-of-hyperbaric-oxygen-therapy-the-protocol-of-the-prospective-cohort-protreat-study-conducted-at-a-tertiary-hospital-in-copenhagen-denmark
#2
Peter Polzik, Pär I Johansson, Ole Hyldegaard
INTRODUCTION: Not enough is known regarding the prognosis and treatment of necrotising soft tissue infections (NSTIs). Mortality has been shown to be 25%-35%, with survivors coping with amputations and prolonged rehabilitation. This study will evaluate soluble urokinase-type plasminogen activator receptor (suPAR) as a possible prognostic marker of NSTI severity and mortality, as well as whether hyperbaric oxygen therapy (HBOT) can modulate markers of endothelial damage during NSTI. We hypothesise that in patients with NSTI, suPAR can provide prognostic risk assessment on hospital admission and that HBOT can reduce the endothelial damage that these patients are exposed to...
October 5, 2017: BMJ Open
https://www.readbyqxmd.com/read/28960161/geriatric-comanagement-reduces-perioperative-complications-and-shortens-duration-of-hospital-stay-after-lumbar-spine-surgery-a-prospective-single-institution-experience
#3
Owoicho Adogwa, Aladine A Elsamadicy, Victoria D Vuong, Jessica Moreno, Joseph Cheng, Isaac O Karikari, Carlos A Bagley
OBJECTIVE Geriatric patients undergoing lumbar spine surgery have unique needs due to the physiological changes of aging. They are at risk for adverse outcomes such as delirium, infection, and iatrogenic complications, and these complications, in turn, contribute to the risk of functional decline, nursing home admission, and death. Whether preoperative and perioperative comanagement by a geriatrician reduces the incidence of in-hospital complications and length of in-hospital stay after elective lumbar spine surgery remains unknown...
September 29, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28948012/enhanced-recovery-protocols-for-colorectal-surgery-and-postoperative-renal-function-a-retrospective-review
#4
Charles R Horres, Mohamed A Adam, Zhifei Sun, Julie K Thacker, Richard E Moon, Timothy E Miller, Stuart A Grant
BACKGROUND: While enhanced recovery protocols (ERPs) reduce physiologic stress and improve outcomes in general, their effects on postoperative renal function have not been directly studied. METHODS: Patients undergoing major colorectal surgery under ERP (February 2010 to March 2013) were compared with a traditional care control group (October 2004 October 2007) at a single institution. Multivariable regression models examined the association of ERP with postoperative creatinine changes and incidence of postoperative acute kidney dysfunction (based on the Risk, Injury, Failure, Loss, and End-stage renal disease criteria)...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28934782/the-dose-dependent-effects-of-ketoprofen-on-dynamic-pain-after-open-heart-surgery
#5
Vedat Eljezi, Claire Biboulet, Henri Boby, Pierre Schoeffler, Bruno Pereira, Christian Duale
BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce postoperative pain, in both static (i.e., at rest) and dynamic contexts (e.g., during coughing or mobilization), and reduced doses could improve their efficacy/tolerance balance. OBJECTIVES: To test this hypothesis of efficacy after open heart surgery, in which NSAIDs are poorly used, particularly for safety concerns. STUDY DESIGN: Randomized, double-blind trial. SETTING: Single-center, French university hospital...
September 2017: Pain Physician
https://www.readbyqxmd.com/read/28933805/perioperative-administration-of-buffered-versus-non-buffered-crystalloid-intravenous-fluid-to-improve-outcomes-following-adult-surgical-procedures
#6
REVIEW
Sohail Bampoe, Peter M Odor, Ahilanandan Dushianthan, Elliott Bennett-Guerrero, Suzie Cro, Tong J Gan, Michael Pw Grocott, Michael Fm James, Michael G Mythen, Catherine Mn O'Malley, Anthony M Roche, Kathy Rowan, Edward Burdett
BACKGROUND: Perioperative fluid strategies influence clinical outcomes following major surgery. Many intravenous fluid preparations are based on simple solutions, such as normal saline, that feature an electrolyte composition that differs from that of physiological plasma. Buffered fluids have a theoretical advantage of containing a substrate that acts to maintain the body's acid-base status - typically a bicarbonate or a bicarbonate precursor such as maleate, gluconate, lactate, or acetate...
September 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28918773/contribution-of-prior-multiple-and-repetitive-surgeries-to-the-risk-of-surgical-site-infections-in-the-netherlands
#7
Janneke D M Verberk, Anouk P Meijs, Margreet C Vos, Liesbeth M A Schreurs, Suzanne E Geerlings, Sabine C de Greeff, Mayke B G Koek
OBJECTIVE Surveillance is an important strategy to reduce the incidence of surgical site infections (SSIs). We investigated whether prior, multiple-, or repetitive surgeries are risk factors for SSI and whether they should be preserved in the protocol of the Dutch national SSI surveillance network. METHODS Dutch national SSI surveillance data 2012-2015 were selected, including 34 commonly performed procedures from 8 major surgical specialties. Definitions of SSIs followed international standardized criteria...
September 18, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28890040/risk-of-deep-vein-thrombosis-in-neurosurgery-state-of-the-art-on-prophylaxis-protocols-and-best-clinical-practices
#8
REVIEW
Mario Ganau, Lara Prisco, Helene Cebula, Julien Todeschi, Houssem Abid, Gianfranco Ligarotti, Raoul Pop, Francois Proust, Salvatore Chibbaro
OBJECTIVE: To analytically discuss some protocols in Deep vein thrombosis (DVT)/pulmonary Embolism (PE) prophylaxis currently use in Neurosurgical Departments around the world. DATA SOURCES: Analysis of the prophylaxis protocols in the English literature: An analytical and narrative review of literature concerning DVT prophylaxis protocols in Neurosurgery have been conducted by a PubMed search (back to 1978). DATA EXTRACTION: 80 abstracts were reviewed, and 74 articles were extracted...
September 7, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28870735/percutaneous-osteotomies-in-hallux-valgus-a-systematic-review
#9
REVIEW
Ana Bia, Francisco Guerra-Pinto, Bruno S Pereira, Nuno Corte-Real, Xavier Martin Oliva
Percutaneous and minimally invasive surgery is one of the greatest advances in the operating field of orthopedic since the late 1990s. The potential advantages include a shorter operative time, quicker recovery, and reduced hospital stay compared with traditional open surgery. However, scientific validation of the safety and efficacy of hallux valgus (HV) percutaneous surgery remains inconclusive. The objective of the present study was to systematically review the published data and clinical evidence for percutaneous HV surgery, evaluate the scientific method of the reports, and clarify the indications, safety, efficacy, and potential risks of these surgical techniques...
September 1, 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28865463/carbon-ion-radiotherapy-for-non-small-cell-lung-cancer-with-interstitial-lung-disease-a%C3%A2-retrospective-analysis
#10
Mio Nakajima, Naoyoshi Yamamoto, Kazuhiko Hayashi, Masataka Karube, Daniel K Ebner, Wataru Takahashi, Makoto Anzai, Kenji Tsushima, Yuji Tada, Koichiro Tatsumi, Tadaaiki Miyamoto, Hiroshi Tsuji, Takehiko Fujisawa, Tadashi Kamada
BACKGROUND: Lung cancer is frequently complicated by interstitial lung disease (ILD). Treatment protocols for lung cancer patients with ILD have not been established; surgery, chemotherapy, and radiotherapy can all cause acute exacerbation of ILD. This study evaluated the toxicity and efficacy of carbon ion radiotherapy (CIRT) in patients with non-small cell lung cancer (NSCLC) and ILD. METHODS: Between June 2004 and November 2014, 29 patients diagnosed with NSCLC and ILD were treated with CIRT...
September 2, 2017: Radiation Oncology
https://www.readbyqxmd.com/read/28860401/venous-thromboembolism-in-adult-elective-spinal-surgery-a-tertiary-centre-review-of-2181-patients
#11
H M T Fawi, K Saba, A Cunningham, S Masud, M Lewis, M Hossain, I Chopra, S Ahuja
AIMS: To evaluate the incidence of primary venous thromboembolism (VTE), epidural haematoma, surgical site infection (SSI), and 90-day mortality after elective spinal surgery, and the effect of two protocols for prophylaxis. PATIENTS AND METHODS: A total of 2181 adults underwent 2366 elective spinal procedures between January 2007 and January 2012. All patients wore anti-embolic stockings, mobilised early and were kept adequately hydrated. In addition, 29% (689) of these were given low molecular weight heparin (LMWH) while in hospital...
September 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28854533/safety-aspects-of-preoperative-high-dose-glucocorticoid-in-primary-total-knee-replacement
#12
C C Jørgensen, F T Pitter, H Kehlet
Background: Preoperative single high-dose glucocorticoid may have early outcome benefits in total hip arthroplasty (THA) and knee arthroplasty (TKA), but long-term safety aspects have not been evaluated. Methods: From October 2013, the departments reporting to the prospective Lundbeck Foundation Database for Fast-track Hip and Knee Replacement introduced preoperative methylprednisolone (MP) 125 mg as part of a multimodal analgesic protocol in TKA. We analysed the risk of length of hospital stay (LOS) >4 days, 30 and 90 day readmissions in patients with MP vs patients having TKA before the use of MP and adjusted for comorbidity and place of surgery...
August 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28852575/a-protocol-for-diagnosis-and-management-of-aortic-atherosclerosis-in-cardiac-surgery-patients
#13
REVIEW
Wouter W Jansen Klomp, George J Brandon Bravo Bruinsma, Arnoud W J Van 't Hof, Jan G Grandjean, Arno P Nierich
In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE (A-View method) was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening. At the time of clinical implementation and validation, we did not yet standardize the indications for modified TEE and the changes in patient management in the presence of aortic atherosclerosis. Therefore, we designed a protocol, which combined the diagnosis of atherosclerosis of thoracic aorta and the subsequent considerations with respect to the intraoperative management and provides a systematic approach to reduce the risk of cerebral complications...
2017: International Journal of Vascular Medicine
https://www.readbyqxmd.com/read/28851694/dose-optimisation-of-intravenous-tranexamic-acid-for-elective-hip-and-knee-arthroplasty-the-effectiveness-of-a-single-pre-operative-dose
#14
R J M Morrison, B Tsang, W Fishley, I Harper, J C Joseph, M R Reed
OBJECTIVES: We have increased the dose of tranexamic acid (TXA) in our enhanced total joint recovery protocol at our institution from 15 mg/kg to 30 mg/kg (maximum 2.5 g) as a single, intravenous (IV) dose. We report the clinical effect of this dosage change. METHODS: We retrospectively compared two cohorts of consecutive patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery in our unit between 2008 and 2013. One group received IV TXA 15 mg/kg, maximum 1...
August 2017: Bone & Joint Research
https://www.readbyqxmd.com/read/28851521/incidence-of-bone-protection-and-associated-fragility-injuries-in-patients-with-proximal-femur-fractures
#15
Ignacio Aguado-Maestro, Michalis Panteli, Manuel García-Alonso, Alejandro Bañuelos-Díaz, Peter V Giannoudis
OBJECTIVES: Our aim was to investigate whether patients presenting with fragility fractures of the proximal femur are receiving osteoporosis treatment and to assess the number of other fragility fractures they have sustained prior to admission. METHODS: All patients presenting to our institution with fragility fractures of the proximal femur within an 18-month period (January 2012-August 2013) were included. Patient demographics; fracture classification (AO/OTA); American Society of Anesthesiologists (ASA) grade; Abbreviated Mental Test Score (AMTS) on admission; type of operation; time to operation; peri-operative complications; length of hospital stay (LOS); walking status; osteoporotic medication; Dual-energy X-ray absorptiometry (DEXA) results; additional fragility fractures; and mortality were collected and analysed...
August 26, 2017: Injury
https://www.readbyqxmd.com/read/28841916/neoadjuvant-chemotherapy-versus-surgery-first-for-resectable-pancreatic-cancer-norwegian-pancreatic-cancer-trial-1-norpact-1-study-protocol-for-a-national-multicentre-randomized-controlled-trial
#16
Knut Jørgen Labori, Kristoffer Lassen, Dag Hoem, Jon Erik Grønbech, Jon Arne Søreide, Kim Mortensen, Rune Smaaland, Halfdan Sorbye, Caroline Verbeke, Svein Dueland
BACKGROUND: Pancreatic cancer is the fourth leading cause of cancer-related death. While surgical resection remains the foundation for potentially curative treatment, survival benefit is achieved with adjuvant oncological treatment. Thus, completion of multimodality treatment (surgical resection and (neo)adjuvant chemotherapy) to all patients and early treatment of micrometastatic disease is the ideal goal. NorPACT-1 aims to test the hypothesis that overall mortality at one year after allocation of treatment can be reduced with neoadjuvant chemotherapy in surgically treated patients with resectable pancreatic cancer...
August 25, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28839987/effect-of-huisheng-oral-solution-on-coagulation-function-in-perioperative-period-in-patients-with-primary-lung-cancer
#17
Xiaoguang Yang, Helin Zhang, Fanyi Kong, Guochen Wang, Qianyu Gu, Zheng Zhao, Tiezhi Li, Mingming Ren, Zuosheng Li, Yang Guo
BACKGROUND: The incidence of venous thromboembolism (VTE) is about 4-10% in lung cancer patients. Huisheng oral solution (HSOS) has been previously demonstrated to inhibit carageenan induced acute thrombosis in rats, reduce the incidence of thrombosis in the lungs and mesentery of tumor-bearing mice and inhibit tumor cell metastasis. The purpose of this study was to assess the anticoagulant effect of HSOS in lung cancer patients in the perioperative period. METHODS: This study was a multicenter, randomized, single-blind, blank-controlled clinical trial...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28836973/comparison-and-analysis-of-reoperations-in-two-different-treatment-protocols-for-trochanteric-hip-fractures-postoperative-technical-complications-with-dynamic-hip-screw-intramedullary-nail-and-medoff-sliding-plate
#18
Johnny Paulsson, Josefine Corin Stig, Ola Olsson
BACKGROUND: In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension...
August 24, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28835268/perioperative-antibiotic-prophylaxis-in-the-treatment-of-acute-cholecystitis-peanuts-ii-trial-study-protocol-for-a-randomized-controlled-trial
#19
Charlotte S Loozen, Hjalmar C van Santvoort, Antoinette A W van Geloven, Grard A P Nieuwenhuijzen, Philip R de Reuver, Mark H G Besselink, Bart Vlaminckx, Johannes C Kelder, Catherijne A J Knibbe, Djamila Boerma
BACKGROUND: The additional value of perioperative antibiotic prophylaxis in preventing infectious complications after emergency cholecystectomy for acute cholecystitis is a much-debated subject in the surgical community. Evidence-based guidelines are lacking, and consequently the use of antibiotic prophylaxis varies greatly among surgeons and hospitals. Recently, high-level evidence became available demonstrating that postoperative antibiotic prophylaxis in patients with acute cholecystitis does not reduce the risk of infectious complications...
August 23, 2017: Trials
https://www.readbyqxmd.com/read/28820797/postoperative-renal-dysfunction-after-noncardiac-surgery
#20
Suvi T Vaara, Rinaldo Bellomo
PURPOSE OF REVIEW: The narrative review aims to discuss recent results and important knowledge gaps regarding acute kidney injury (AKI) in postoperative patients undergone major noncardiac surgery. RECENT FINDINGS: Postoperative AKI affects approximately one-fifth of patients after major surgery, but the incidence varies according to the type of surgery. Preexisting chronic kidney disease is a major risk factor for postoperative AKI. It carries a substantial risk for postoperative adverse outcomes, as well as long-term mortality and morbidity...
October 2017: Current Opinion in Critical Care
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