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Protocols to reduce risk in surgery

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https://www.readbyqxmd.com/read/29678147/protocol-based-evaluation-for-feasibility-of-extubation-compared-to-clinical-scoring-systems-after-major-oral-cancer-surgery-safely-reduces-the-need-for-tracheostomy-a-retrospective-cohort-study
#1
Axel Schmutz, Rolf Dieterich, Johannes Kalbhenn, Pit Voss, Torsten Loop, Sebastian Heinrich
BACKGROUND: Despite risks, complications and negative impact to quality of life, tracheostomy is widely used to bypass upper airway obstruction after major oral cancer surgery (MOCS). Decision to tracheostomy is frequently based on clinical scoring systems which mainly have not been validated by different cohorts. Delayed extubation in the Intensive Care Unit (ICU) may be a suitable alternative in selected cases. We hypothesize that delayed routine ICU extubation after MOCS instead of scoring system based tracheostomy is safe, feasible and leads to lower tracheostomy rates...
April 20, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29666130/does-dexmedetomidine-given-as-a-premedication-or-intraoperatively-reduce-post-hospitalisation-behaviour-change-in-children-a-study-protocol-for-a-randomised-controlled-trial-in-a-tertiary-paediatric-hospital
#2
Paul Lee-Archer, Craig McBride, Rebecca Paterson, Michael Reade, Britta Regli-von Ungern-Sternberg, Deborah Long
INTRODUCTION: It has been reported that post-hospitalisation behaviour change (PHBC) occurs in over 50% of children undergoing a general anaesthetic and manifests as behaviours such as sleep and eating disorders, defiance of authority, nightmares, enuresis and temper tantrums. The effect is usually short-lived (2-4 weeks); however, in 5-10% of children, these behaviours can last up to 12 months. The risk factors for developing PHBC include underlying anxiety in the child or parent, a previous bad hospital experience, emergence delirium and preschool age...
April 17, 2018: BMJ Open
https://www.readbyqxmd.com/read/29600816/comparison-of-chlorhexidine-isopropanol-with-isopropanol-skin-antisepsis-for-prevention-of-surgical-site-infection-after-abdominal-surgery
#3
J C Harnoss, O Assadian, A Kramer, P Probst, C Müller-Lantzsch, L Scheerer, T Bruckner, M K Diener, M W Büchler, A B Ulrich
BACKGROUND: Prevention of surgical-site infection (SSI) has received increasing attention. Clinical trials have focused on the role of skin antisepsis in preventing SSI. The benefit of combining antiseptic chlorhexidine with alcohol has not been compared with alcohol-based skin preparation alone in a prospective controlled clinical trial. METHODS: Between August and October 2014, patients undergoing abdominal surgery received preoperative skin antisepsis with 70 per cent isopropanol (PA)...
March 30, 2018: British Journal of Surgery
https://www.readbyqxmd.com/read/29600335/radiation-exposure-for-intraoperative-3d-scans-in-a-hybrid-operating-room-how-to-reduce-radiation-exposure-for-the-surgical-team
#4
K Schuetze, M Kraus, A Eickhoff, F Gebhard, P H Richter
BACKGROUND: Hybrid operating rooms are used in different fields of surgery. In orthopedic surgery, the possibility of a 3D scan of difficult anatomical regions (spine, pelvis) showed promising results not only in navigated screw placement. The associated exposure to radiation raises questions regarding potential risks for the operating room personal and the patient. The present study focuses on scatter radiation during 3D scans in a hybrid operating room, the adjacent rooms, and methods to reduce radiation exposure...
March 29, 2018: International Journal of Computer Assisted Radiology and Surgery
https://www.readbyqxmd.com/read/29587583/systematic-review-and-meta-analysis-of-unplanned-reoperations-emergency-department-visits-and-hospital-readmission-after-thyroidectomy
#5
Joseph Margolick, Wenjia Chen, Sam Wiseman
BACKGROUND: Unplanned reoperation, Emergency Department (ED) visits, and hospital readmission following thyroid operations usually arise due to complications, and are a source of frustration for both surgeons and patients. With an aim to provide insight important for the development of patient quality care improvement initiatives, the primary objective of this review was to systematically evaluate the available literature in order to determine the contemporary rates of reoperation, readmission and ED visits following thyroid operations...
March 27, 2018: Thyroid: Official Journal of the American Thyroid Association
https://www.readbyqxmd.com/read/29582969/incidence-and-risk-factors-of-neurosurgical-site-infections-results-of-a-prospective-multicenter-cohort-study-on-6359-surgeries
#6
Laura Valentini, Francesca Chiaffarino, Nicoletta Bonfanti, Marilou Pannacci, Paolo Cortellazzi, Caterina Uberti-Foppa, Marika Furlanetto, Francesco DI Meco, Luca Massimi
OBJECTIVES: Neurosurgical surgical site infections (SSI) are life-threatening complications, requiring medical treatment and additional surgeries and remain a substantial cause of morbidity. In order to identify the incidence and the main risk factors for SSI, we developed the Prophylaxis with Antibiotic protocol for neuroSurgical Site Infections Study (PASSIS), a prospective observational multicenter cohort study for examining a large number of neurosurgical procedures. METHODS: The study PASSIS involved four Italian Neurosurgical Departments applying the same antibiotic prophylaxis (ABP) protocol on 6359 consecutive neurosurgical procedures...
March 26, 2018: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/29582944/-percutaneous-treatment-of-small-renal-tumors-by-thermal-ablation
#7
Amitay Lorber, Nahum S Goldberg, Ofer N Gofrit, Dov Pode, Vladimir Yutkin, Ilan Gielchinsky, Mordechai Duvdevani, Ezekiel H Landau, Guy Hidas, Liat Apelbaum
INTRODUCTION: Kidney cancer accounts for approximately 2-3 % of all types of cancers. Renal tumors prevalence and especially the prevalence of small renal tumors, is on the rise. About half of the tumors currently diagnosed are smaller than 4 cm. Minimally invasive methods of radiofrequency ablation technology were recently developed for the treatment of small renal tumors and are characterized by reducing the surgical and anesthetic risk. The ablation is performed with a percutaneous approach guided by ultrasound, CT or MRI...
March 2018: Harefuah
https://www.readbyqxmd.com/read/29574681/effect-of-goal-directed-haemodynamic-therapy-in-free-flap-reconstruction-for-head-and-neck-cancer
#8
H J Kim, E J Kim, H J Lee, J Y Min, T W Kim, E C Choi, W S Kim, B-N Koo
BACKGROUND: In free flap reconstruction for head and neck cancer, achieving a haemodynamic target using excessive fluid infusion is associated with decreased flap survival rates and extended hospital stays. We hypothesized that goal-directed haemodynamic therapy would improve flap survival rates and shorten hospitalization periods. METHODS: Patients scheduled for free flap reconstruction were randomly assigned to a goal-directed haemodynamic therapy group (n = 31) or a conventional haemodynamic therapy control group (n = 31)...
March 25, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29574549/simultaneous-same-anaesthetic-bilateral-total-knee-arthroplasty-has-low-mortality-and-complication-rates
#9
Eugene Wong, Chu Luan Nguyen, Sean Park, David Parker
PURPOSE: The benefits of simultaneous bilateral total knee arthroplasty (SBTKR) include reduced hospital costs, single anaesthetic exposure and in many cases is also the patient's preference. Despite these potential benefits, risk-adversity with respect to assumed complications and mortality make it difficult for the orthopaedic surgeon and patient to make an informed decision. This study aimed to address the inconsistencies and lack of consensus in previous literature regarding the short-term complications and clinical safety of SBTKR in patients with end-stage knee osteoarthritis (OA)...
March 24, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/29544497/interview-based-malnutrition-assessment-can-predict-adverse-events-within-6-months-after-primary-and-revision-arthroplasty-a-prospective-observational-study-of-351-patients
#10
Christoph Ihle, Christoph Weiß, Gunnar Blumenstock, Ulrich Stöckle, Björn Gunnar Ochs, Christian Bahrs, Andreas Nüssler, Anna Janine Schreiner
BACKGROUND: Being at risk for malnutrition can be observed among hospitalized patients of all medical specialties. There are only few studies in arthroplasty dealing with defining and assessing malnutrition as such a potentially risk. This study aims to identify the risk for malnutrition following primary (pAP) and revision arthroplasty (rAP) (1) using non-invasive interview based assessment tools and to analyze effects on clinical outcome (2) and quality of life (3). METHODS: A consecutive series of hospitalized patients of a Department of Arthroplasty at a Level 1 Trauma Center in Western Europe was observed between June 2014 and June 2016...
March 15, 2018: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29539628/prenatal-abo-rhd-genotyping-a-new-paradigm-to-allow-for-fresh-whole-blood-for-cardiopulmonary-bypass-in-the-immediate-newborn-period
#11
Juliet Chhay Bishop, Karin Blakemore, Luca Vricella, Priya Sekar, Katelynn Sagaser, Jude Crino, Paul Ness, Benjamin K Kogutt, Joan Boyd, Susan Aucott, Angie C Jelin, Joanne Chiu, Eric Gehrie, Kristen Nelson McMillan
Compared to standard component therapy, fresh whole blood (FWB) offers potential benefits to neonates undergoing cardiopulmonary bypass (CPB) in the context of open cardiac surgery: decreased blood loss and subsequent risk of volume overload, improved coagulation status, higher platelet counts during and following CPB, circumvention of limited vascular access, and significantly reduced donor exposures. Obtaining FWB, however, entails 2-5 days of preparation, which often precludes its availability for neonates requiring CPB in the immediate newborn period...
March 14, 2018: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/29537981/hyperinsulinemic-normoglycemia-during-cardiac-surgery-reduces-a-composite-of-30-day-mortality-and-serious-in-hospital-complications-a-randomized-clinical-trial
#12
Andra E Duncan, Daniel I Sessler, Hiroaki Sato, Tamaki Sato, Keisuke Nakazawa, George Carvalho, Roupen Hatzakorzian, Takumi Codere-Maruyama, Alaa Abd-Elsayed, Somnath Bose, Tamer Said, Maria Mendoza-Cuartas, Hyndhavi Chowdary, Edward J Mascha, Dongsheng Yang, A Marc Gillinov, Thomas Schricker
BACKGROUND: Hyperinsulinemic normoglycemia augments myocardial glucose uptake and utilization. We tested the hypothesis that hyperinsulinemic normoglycemia reduces 30-day mortality and morbidity after cardiac surgery. METHODS: This dual-center, parallel-group, superiority trial randomized cardiac surgical patients between August 2007 and March 2015 at the Cleveland Clinic, Cleveland, Ohio, and Royal Victoria Hospital, Montreal, Canada, to intraoperative glycemic management with (1) hyperinsulinemic normoglycemia, a fixed high-dose insulin and concomitant variable glucose infusion titrated to glucose concentrations of 80 to 110 mg · dl; or (2) standard glycemic management, low-dose insulin infusion targeting glucose greater than 150 mg · dl...
March 14, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29528419/evaluation-of-stereotactic-radiotherapy-of-the-resection-cavity-after-surgery-of-brain-metastases-compared-to-postoperative-whole-brain-radiotherapy-estron-a-single-center-prospective-randomized-trial
#13
Rami A El Shafie, Angela Paul, Denise Bernhardt, Henrik Hauswald, Thomas Welzel, Tanja Sprave, Adriane Hommertgen, Johannes Krisam, Daniela Schmitt, Sebastian Klüter, Kai Schubert, Christina Klose, Meinhard Kieser, Jürgen Debus, Stefan Rieken
BACKGROUND: Neurosurgical resection is recommended for symptomatic brain metastases, in oligometastatic patients or for histology acquisition. Without adjuvant radiotherapy, roughly two-thirds of the patients relapse at the resection site within 24 mo, while the risk of new metastases in the untreated brain is around 50%. Adjuvant whole-brain radiotherapy (WBRT) can reduce the risk of both scenarios of recurrence significantly, although the associated neurocognitive toxicity is substantial, while stereotactic radiotherapy (SRT) improves local control at comparably low toxicity...
March 8, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29526330/reducing-hypotension-and-acute-kidney-injury-in-the-elective-total-joint-arthroplasty-population-a-multi-disciplinary-approach
#14
Vince W Lands, Ajith Malige, Aldo Carmona, Christopher R Roscher, Robert S Gayner, Jaclyn Rowbotham, William G DeLong
BACKGROUND: When critically analyzing our hospital system's rate of hypotension and acute kidney injury (AKI) after total joint arthroplasty, our incidence rates (14.54%, 6.02%) were much higher than our peers (7.17%, 2.03%) and national rates (2.0%, 3.3%). We present a multi-disciplinary management intervention that aimed to decrease overall complication rates. METHOD: A multi-disciplinary team implemented a protocol at our suburban hospital to limit complication rates after joint replacement surgery...
February 5, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29512121/randomized-controlled-trial-of-intra-articular-ketorolac-on-pain-and-inflammation-after-minor-arthroscopic-knee-surgery
#15
N Solheim, I Gregersen, B Halvorsen, V Bjerkeli, A Stubhaug, T Gordh, L A Rosseland
BACKGROUND: Ketorolac is an effective non-steroidal anti-inflammatory drug, commonly used with local anaesthetics as part of local infiltration analgesia protocols following orthopaedic surgery. However, systemic uptake and drug action may be the major mechanism after local infiltration. The aims of this project were to study the effects of a small, systemically ineffective dose of ketorolac given intra-articularly for post-operative pain and also to study synovial inflammatory biomarkers...
March 7, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29510815/onstep-repair-of-inguinal-hernias
#16
Kristoffer Andresen
Inguinal hernias are a protrusion of the peritoneum through a weakening in the groin in which abdominal content (intestines or fat) can herniate and cause a bulge. Inguinal hernias can be painful and require surgery. Worldwide, approximately 20 million patients are operated each year, with 10,000 in Denmark. The repair of inguinal hernias causes pain and 16% of patients experience chronic pain six months after the standard, open, mesh-based Lichtenstein technique. Therefore, surgeons are trying to improve the techniques by finding new ways of operating...
March 2018: Danish Medical Journal
https://www.readbyqxmd.com/read/29506931/maximizing-physician-hospital-alignment-lessons-learned-from-effective-models-of-joint-arthroplasty-care
#17
P Maxwell Courtney, Michael E West, William J Hozack
BACKGROUND: With recent healthcare reform efforts focusing on rewarding value instead of volume, it has become important for orthopedic surgeons to partner and align with their hospitals. We report our experience in aligning clinical and financial incentives with 6 health systems in our geographic area. METHODS: By managing the entire episode-of-care continuum for total hip and total knee arthroplasty patients, our standardized, evidence-based protocols have improved the quality of care for our joint arthroplasty patients...
January 31, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29499423/praying-sitting-position-for-pineal-region-surgery-an-efficient-variant-of-a-classic-positioning-in-neurosurgery
#18
Joham Choque-Velasquez, Roberto Colasanti, Julio C Resendiz-Nieves, Kléber E Gonzáles-Echevarría, Rahul Raj, Behnam Rezai Jahromi, Felix Goehre, Ann-Christine Lindroos, Juha Hernesniemi
OBJECTIVE: Nowadays, the sitting position has lost favor among neurosurgeons partly due to assumptions of increased complications, such as venous air embolisms (VAEs) and hemodynamic disturbances. Moreover, it may oblige the surgeon to a tiring posture. Herein, we describe our protocol for the "praying (steeper sitting) position" for pineal region surgery, a variant which may reduce some of the risks of the sitting position while providing a more ergonomic surgical position...
February 27, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29498571/the-role-of-preoperative-deep-vein-thrombosis-screening-in-neurooncology
#19
Anmol Pandey, Bhaskar Thakur, Florence Hogg, Christian Brogna, Jamie Logan, Roopen Arya, Richard Gullan, Ranjeev Bhangoo, Keyoumars Ashkan
OBJECTIVE Venous thromboembolism (VTE) is a major cause of morbidity in patients undergoing neurosurgical intervention. The authors postulate that the introduction of a routine preoperative deep vein thrombosis (DVT) screening protocol for patients undergoing neurosurgical intervention for brain tumors would result in a more effective diagnosis of DVT in this high-risk subgroup, and subsequent appropriate management of the condition would reduce pulmonary embolism (PE) rates and improve patient outcomes. METHODS The authors conducted a prospective study of 115 adult patients who were undergoing surgical intervention for a brain tumor...
March 2, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29490967/effectiveness-of-postdischarge-interventions-for-reducing-the-severity-of-chronic-pain-after-total-knee-replacement-systematic-review-of-randomised-controlled-trials
#20
Vikki Wylde, Jane Dennis, Rachael Gooberman-Hill, Andrew David Beswick
OBJECTIVE: Approximately 20% of patients experience chronic pain after total knee replacement (TKR). The aim of this systematic review was to evaluate the effectiveness of postdischarge interventions commenced in the first 3 months after surgery in reducing the severity of chronic pain after TKR. DESIGN: The protocol for this systematic review was registered on PROSPERO (registration number: CRD42017041382). MEDLINE, Embase, CINAHL, PsycINFO and The Cochrane Library were searched from inception to November 2016...
February 28, 2018: BMJ Open
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