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Protocols to reduce risk in surgery

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https://www.readbyqxmd.com/read/28320201/analysis-of-never-events-following-adult-cardiac-surgical-procedures-in-the-united-states
#1
Michael P Robich, Brianna M Krafcik, Nishant K Shah, Alik Farber, Denis Rybin, Jeffrey J Siracuse
BACKGROUND: This study was conducted to determine the risk factors, nature, and outcomes of "never events" following open adult cardiac surgical procedures. Understanding of these events can reduce their occurrence, and thereby improve patient care, quality metrics, and cost reduction. METHODS: "Never events" for patients included in the Nationwide Inpatient Sample who underwent coronary artery bypass graft, heart valve repair/replacement, or thoracic aneurysm repair between 2003-2011 were documented...
March 16, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28314837/risk-reducing-strategies-for-ovarian-cancer-in-brca-mutation-carriers-a-balancing-act
#2
Roi Tschernichovsky, Annekathryn Goodman
OBJECTIVE: The objective of this study was to review the role of bilateral salpingo-oophorectomy in BRCA mutation (mBRCA) carriers and alternative interventions in risk reduction of ovarian cancer (OC). MATERIALS AND METHODS: A systematic review using PubMed, MEDLINE, EMBASE, and the Cochrane library was conducted to identify studies of different strategies to prevent OC in mBRCA carriers, including bilateral salpingo-oophorectomy, prophylactic salpingectomy with delayed oophorectomy, intensive surveillance, and chemoprevention...
March 17, 2017: Oncologist
https://www.readbyqxmd.com/read/28299272/three-dimensional-planning-in-craniomaxillofacial-surgery
#3
Josep Rubio-Palau, Alejandra Prieto-Gundin, Asteria Albert Cazalla, Miguel Bejarano Serrano, Gemma Garcia Fructuoso, Francisco Parri Ferrandis, Alejandro Rivera Baró
INTRODUCTION: Three-dimensional (3D) planning in oral and maxillofacial surgery has become a standard in the planification of a variety of conditions such as dental implants and orthognathic surgery. By using custom-made cutting and positioning guides, the virtual surgery is exported to the operating room, increasing precision and improving results. MATERIALS AND METHODS: We present our experience in the treatment of craniofacial deformities with 3D planning. Software to plan the different procedures has been selected for each case, depending on the procedure (Nobel Clinician, Kodak 3DS, Simplant O&O, Dolphin 3D, Timeus, Mimics and 3-Matic)...
July 2016: Annals of Maxillofacial Surgery
https://www.readbyqxmd.com/read/28298244/frailty-related-to-anesthesia-guided-by-the-index-bispectral-frail-study-study-protocol-for-a-randomized-controlled-trial
#4
Morgan Le Guen, Marie Herr, Antoine Bizard, Caroline Bichon, Nathalie Boichut, Thierry Chazot, Ngai Liu, Joel Ankri, Marc Fischler
BACKGROUND: Currently, patients older than 60 years of age represent 25% of the population and are at an increased risk during surgery. Therefore, reducing postoperative morbidity and mortality is a major concern in medical research and practice. Dependence on caregivers and cognitive impairment represent two major risk factors in the elderly, especially in frail patients after surgery under general anesthesia. In this context, continuous monitoring of the depth of anesthesia using a bispectral index (BIS) sensor may reduce the occurrence of impairments by gaining better control of the anesthetic depth...
March 16, 2017: Trials
https://www.readbyqxmd.com/read/28258686/ischaemic-preconditioning-for-the-reduction-of-renal-ischaemia-reperfusion-injury
#5
REVIEW
Theo P Menting, Kimberley E Wever, Denise Md Ozdemir-van Brunschot, Daan Ja Van der Vliet, Maroeska M Rovers, Michiel C Warle
BACKGROUND: Ischaemia reperfusion injury can lead to kidney dysfunction or failure. Ischaemic preconditioning is a short period of deprivation of blood supply to particular organs or tissue, followed by a period of reperfusion. It has the potential to protect kidneys from ischaemia reperfusion injury. OBJECTIVES: This review aimed to look at the benefits and harms of local and remote ischaemic preconditioning to reduce ischaemia and reperfusion injury among people with renal ischaemia reperfusion injury...
March 4, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28248410/low-permanent-pacemaker-rates-following-lotus-device-implantation-for-transcatheter-aortic-valve-replacement-due-to-modified-implantation-protocol
#6
Florian Krackhardt, Behrouz Kherad, Maximilian Krisper, Burkert Pieske, Michael Laule, Carsten Tschöpe
BACKGROUND: Conduction disturbances requiring permanent pacemaker implantation following transcatheter aortic valve replacement (TAVR) are a common problem. Pacemaker implantation rates after TAVR appear to be higher compared to conventional aortic valve replacement. The aim of this study was to analyze whether a high annulus implantation conveys the benefit of a decreased rate of permanent pacemaker implantation while being safe and successful according to VAR2-criteria. METHODS: A total of 23 patients with symptomatic severe aortic valve stenosis, an aortic annulus of 19-27mm and at high risk for surgery were treated with the Lotus valve...
March 1, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28247647/-epidemiology-of-urinary-disorders-in-men-in-the-russian-federation
#7
I A Korneev, T A Alekseeva, M I Kogan, D Yu Pushkar'
AIM: To compare the results of population studies conducted in the Russian Federation to identify the prevalence, severity and risk factors for urinary disorders in men. MATERIALS AND METHODS: Data of a survey of 1083 men were analyzed for the age, weight, height, comorbidities with their signs and symptoms, history of surgery on pelvic organs, copulative disorders, and IPSS and quality of life scores. The findings were compared with the results of a survey of 482 Russian men under the protocol of the International Society of Continence (ICS) aimed to identify patients with overactive bladder (OAB), in whom pollakiuria, nocturia, urgency, urinary incontinence, stress-incontinence, poor flow and terminal dribbling were registered...
April 2016: Urologii︠a︡
https://www.readbyqxmd.com/read/28217303/three-years-evaluation-of-retained-foreign-bodies-after-surgery-in-iran
#8
Mohammad Zarenezhad, Saeed Gholamzadeh, Arya Hedjazi, Kamran Soltani, Jaber Gharehdaghi, Masoud Ghadipasha, Seyyed Mohammad Vahid Hosseini, Ahmad Zare
BACKGROUND: Medical errors such as retained foreign bodies (RFB) during surgery are not well studied. To define risk factors associated with this type of error, we performed retrospective study. METHODS: We reviewed medical records for unintentional foreign object remaining in the body during surgery such as gender, age, surgery ward, and incident reports referred to several forensic medicine administrations as well as adverse effects of retained foreign bodies and methods for detection of them over a 3-years period from January 2008 through May 2011...
March 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28214482/catheter-directed-ultrasound-assisted-thrombolysis-is-a-safe-and-effective-treatment-for-pulmonary-embolism-even-in-high-risk-patients
#9
Kristen A Lee, Andrew Cha, Mark H Kumar, Combiz Rezayat, Clifford M Sales
OBJECTIVE: We sought to assess the early success and safety of catheter-directed, ultrasound-assisted (CDUA) thrombolysis for acute pulmonary embolism (PE) in patients deemed to be "high risk" for thrombolytic therapy. METHODS: A retrospective evaluation of patients who underwent CDUA pulmonary thrombolysis in our practice during 39 months is reported. There were 91 patients considered, all of whom presented with acute PE as diagnosed by computed tomography angiography...
March 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28207669/is-intraoperative-local-vancomycin-powder-the-answer-to-surgical-site-infections-in-spine-surgery
#10
Hwee Weng Dennis Hey, Desmond Wei Thiam, Zhi Seng Darren Koh, Joseph Shantakumar Thambiah, Naresh Kumar, Leok-Lim Lau, Ka-Po Gabriel Liu, Hee-Kit Wong
STUDY DESIGN: This is a retrospective cohort comparative study of all patients who underwent instrumented spine surgery at a single institution. OBJECTIVE: To compare the rate of surgical site infection (SSI) between the treatment (vancomycin) and the control group (no vancomycin) in patients undergoing instrumented spine surgery. SUMMARY OF BACKGROUND DATA: SSI after spine surgery is a dreaded complication associated with increased morbidity and mortality...
February 15, 2017: Spine
https://www.readbyqxmd.com/read/28190762/optimal-fractionation-of-preoperative-radiotherapy-and-timing-to-surgery-for-rectal-cancer-stockholm-iii-a-multicentre-randomised-non-blinded-phase-3-non-inferiority-trial
#11
Johan Erlandsson, Torbjörn Holm, David Pettersson, Åke Berglund, Björn Cedermark, Calin Radu, Hemming Johansson, Mikael Machado, Fredrik Hjern, Olof Hallböök, Ingvar Syk, Bengt Glimelius, Anna Martling
BACKGROUND: Radiotherapy reduces the risk of local recurrence in rectal cancer. However, the optimal radiotherapy fractionation and interval between radiotherapy and surgery is still under debate. We aimed to study recurrence in patients randomised between three different radiotherapy regimens with respect to fractionation and time to surgery. METHODS: In this multicentre, randomised, non-blinded, phase 3, non-inferiority trial (Stockholm III), all patients with a biopsy-proven adenocarcinoma of the rectum, without signs of non-resectability or distant metastases, without severe cardiovascular comorbidity, and planned for an abdominal resection from 18 Swedish hospitals were eligible...
February 9, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28183564/the-effect-of-tramadol-plus-paracetamol-on-consumption-of-morphine-after-coronary-artery-bypass-grafting
#12
Dilek Altun, Özlem Çınar, Emre Özker, Ayda Türköz
STUDY OF OBJECTIVE: To compare the effects of oral tramadol+paracetamol combination on morphine consumption following coronary artery bypass grafting (CABG) in the patient-controlled analgesia (PCA) protocol. DESIGN: A prospective, double-blind, randomized, clinical study. SETTING: Single-institution, tertiary hospital. PATIENTS: Fifty cardiac surgical patients undergoing primary CABG surgery. INTERVENTIONS: After surgery, the patients were allocated to 1 of 2 groups...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28166812/efficacy-of-high-intensity-focused-ultrasound-assisted-hepatic-resection-hifu-ar-on-blood-loss-reduction-in-patients-with-liver-metastases-requiring-hepatectomy-study-protocol-for-a-randomized-controlled-trial
#13
Aurélien Dupré, David Pérol, Ellen Blanc, Patrice Peyrat, Valéria Basso, Yao Chen, Jérémy Vincenot, Anthony Kocot, David Melodelima, Michel Rivoire
BACKGROUND: Liver resection is the only potentially curative treatment for colorectal liver metastases (LM). It is considered a safe procedure, but is often associated with blood loss during liver transection. Blood transfusions are frequently needed, but they are associated with increased morbidity and risk of recurrence. Many surgical devices have been developed to decrease blood loss. However, none of them has proven superior to the standard crushing technique. We developed a new, powerful intra-operative high-intensity focused ultrasound (HIFU) transducer which destroys tissue by coagulative necrosis...
February 6, 2017: Trials
https://www.readbyqxmd.com/read/28161819/optimizing-resection-of-large-colorectal-polyps
#14
REVIEW
Steven J Heitman, David J Tate, Michael J Bourke
Polypectomy reduces the incidence and mortality of colorectal cancer (CRC). The widespread adoption of CRC screening, more rigorous colonoscopy techniques, and advancements in endoscopic imaging have led to a greater awareness of complex polyps. Whereas surgery was once considered necessary for many large sessile or laterally spreading lesions (LSLs) in the colorectum, the majority can now be removed endoscopically. Endoscopic mucosal resection (EMR) is an established technique for treatment of colorectal LSLs...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28161482/evaluation-of-a-standardized-risk-based-venous-thromboembolism-prophylaxis-protocol-in-the-setting-of-thyroid-and-parathyroid-surgery
#15
Ryan Macht, Ivy Gardner, Stephanie Talutis, Pamela Rosenkranz, Gerard Doherty, David McAneny
BACKGROUND: An elevated odds ratio for venous thromboembolism (VTE) prompted development of a Caprini risk assessment and risk-based prophylaxis protocol for all general surgery patients. This system includes pre- and postoperative prophylactic heparin as well as extended courses of low molecular weight heparin for high-risk patients. This study evaluated the safety of this chemoprophylaxis program in thyroid and parathyroid surgery. STUDY DESIGN: A retrospective review was conducted of all general surgery patients undergoing thyroid or parathyroid operations after implementation of the Caprini prophylaxis protocol...
February 2, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28145067/the-bundle-approach-to-reduce-the-surgical-site-infection-rate
#16
Fabrizio Bert, Sebastian Giacomelli, Viola Amprino, Giulio Pieve, Daniela Ceresetti, Marco Testa, Carla M Zotti
RATIONALE, AIMS, AND OBJECTIVES: In Italy, since 2008, the surveillance of surgical site infections (SSIs) has been conducted following ECDC recommendations, according to the protocol of the National System of Surveillance of Surgical Site Infections. In 2009, in Piedmont region, where the study was conducted, it was introduced a survey of a "bundle" for every patient under SSIs surveillance. The bundle includes 5 items: infection risk index calculation, preoperative shower, trichotomy, antibiotic prophylaxis, and body temperature control...
February 1, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28143506/utilization-of-ct-scanning-associated-with-complex-spine-surgery
#17
Vikas V Patel, Gunnar B J Andersson, Steven R Garfin, Donald L Resnick, Jon E Block
BACKGROUND: Due to the risk associated with exposure to ionizing radiation, there is an urgent need to identify areas of CT scanning overutilization. While increased use of diagnostic spinal imaging has been documented, no previous research has estimated the magnitude of follow-up imaging used to evaluate the postoperative spine. METHODS: This retrospective cohort study quantifies the association between spinal surgery and CT utilization. An insurance database (Humana, Inc...
January 31, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28131428/a-new-intraoperative-protocol-for-reducing%C3%A2-perioperative-transfusions-in%C3%A2-cardiac-surgery
#18
J Hunter Mehaffey, Sarah A Schubert, Michael G Gelvin, Eric J Charles, Robert B Hawkins, Lily E Johnston, Gorav Ailawadi, Irving L Kron, Leora T Yarboro
BACKGROUND: Perioperative anemia and blood product transfusion increases short-term and long-term morbidity and mortality during cardiac surgery. We hypothesized that streamlined cardiopulmonary bypass circuit and rotational thromboelastometry (ROTEM) would reduce blood product usage and improve outcomes. METHODS: All patients with Society of Thoracic Surgeons risk scores at our institution from January 2013 to June 2015 were included. Individuals were chronologically stratified into 2 groups according to institutional changes to a streamlined bypass circuit and ROTEM-guided transfusion...
January 25, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28121281/systematic-review-and-meta-analysis-of-endovascular-treatment-for-acute-mesenteric-ischaemia
#19
Marawan El Farargy, Ahmed Abdel Hadi, Mohamed Abou Eisha, Khalid Bashaeb, George A Antoniou
Introduction Acute mesenteric ischaemia is associated with a significant morbidity and mortality. Endovascular techniques have emerged as a viable alternative treatment option to conventional surgery. Our objective was to conduct a systematic review of the literature and perform a meta-analysis of reported outcomes. Methods Our review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards and the protocol was registered in PROSPERO (CRD42016035667). We searched electronic information sources (MEDLINE, EMBASE, CINAHL, CENTRAL) and bibliographic lists of relevant articles to identify studies reporting outcomes of endovascular treatment for acute mesenteric ischaemia of embolic or thrombotic aetiology...
January 1, 2017: Vascular
https://www.readbyqxmd.com/read/28120089/awake-craniotomy-for-tumor-resection-further-optimizing-therapy-of-brain-tumors
#20
H Maximilian Mehdorn, Felix Schwartz, Juliane Becker
In recent years more and more data have emerged linking the most radical resection to prolonged survival in patients harboring brain tumors. Since total tumor resection could increase postoperative morbidity, many methods have been suggested to reduce the risk of postoperative neurological deficits: awake craniotomy with the possibility of continuous patient-surgeon communication is one of the possibilities of finding out how radical a tumor resection can possibly be without causing permanent harm to the patient...
2017: Acta Neurochirurgica. Supplement
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