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emergency surgical risk

David A Mahvi, Rong Liu, Mark W Grinstaff, Yolonda L Colson, Chandrajit P Raut
Locoregional recurrence negatively impacts both long-term survival and quality of life for several malignancies. For appropriate-risk patients with an isolated, resectable, local recurrence, surgery represents the only potentially curative therapy. However, oncologic outcomes remain inferior for patients with locally recurrent disease even after macroscopically complete resection. Unfortunately, these operations are often extensive, with significant perioperative morbidity and mortality. This review highlights selected malignancies (mesothelioma, sarcoma, lung cancer, breast cancer, rectal cancer, and peritoneal surface malignancies) in which surgical resection is a key treatment modality and local recurrence plays a significant role in overall oncologic outcome with regard to survival and quality of life...
October 17, 2018: CA: a Cancer Journal for Clinicians
Thea Helene Degett, Susanne Oksbjerg Dalton, Jane Christensen, Jes Søgaard, Lene Hjerrild Iversen, Ismail Gögenur
PURPOSE: The aim of this study was to investigate if postoperative mortality after acute surgical treatment of colorectal cancer has decreased in Denmark during this period and to investigate risk factors associated with early death. METHODS: This is a nationwide and population-based cohort study. From the Danish Colorectal Cancer Group database and National Patient Registry, we collected data on all patients operated with bowel resection, diverting stoma only, or placement of an endoscopic stent from 2005 to 2015...
October 16, 2018: International Journal of Colorectal Disease
Renata Zajączkowska, Wojciech Leppert, Joanna Mika, Magdalena Kocot-Kępska, Jarosław Woroń, Anna Wrzosek, Jerzy Wordliczek
Opioids comprise an important group of drugs used in cancer pain pharmacotherapy. In recent years, more and more studies have emerged indicating the potentially immunosuppressive effects of opioid analgesics and their serious consequences, including the risk of cancer progression. The identification of these risks has prompted a search for other effective, and most importantly, safer methods of perioperative analgesic management. Regional analgesia techniques, which allow for a significant reduction in opioid dosing and thus diminish the risk of immunosuppression associated with these drugs, seem to offer substantial hope in this respect...
2018: Pain Research & Management: the Journal of the Canadian Pain Society
B Gerenton, V Moris, H Shipkov, P J Regnard, D Guillier
OBJECTIVE: The management of patients on Vitamine K Antagonist (VKA) anticoagulation is a public health issue with surgery being the primary cause of VKA interruption. The aim of this study was to evaluate the bleeding risk in patients operated on hand surgery without interruption of VKA treatment. PATIENTS AND METHODS: This retrospective, monocentric study was conducted between 2013 and 2015. The inclusion criteria were, as follows: patients on VKA over 18 years of age who had emergency or scheduled surgery without interruption of VKA treatment; INR inferior to 3 analyzed less than 24h before surgery...
October 13, 2018: Annales de Chirurgie Plastique et Esthétique
Lawrence M Wei, Dylan P Thibault, J Scott Rankin, Mohamad Alkhouli, Harold G Roberts, Sreekanth Vemulapalli, Babatunde Yerokun, Niv Ad, Hartzell V Schaff, Nicholas G Smedira, Hiroo Takayama, Patrick M McCarthy, Vinod H Thourani, Gorav Ailawadi, Jeffrey P Jacobs, Vinay Badhwar
BACKGROUND: The primary surgical therapy for hypertrophic cardiomyopathy (HCM) with obstruction is septal myectomy (SM). The current outcomes of SM with and without concomitant mitral operations in the United States was examined using The Society of Thoracic Surgeons (STS) database. METHODS: From July 2014 through June 2017, 4,274 SM operations were performed. Emergent status, endocarditis, aortic stenosis, and planned aortic valve operations were excluded. In the final cohort of 2,382 patients, 1,581 (66...
October 13, 2018: Annals of Thoracic Surgery
Matthew C Hernandez, Firas Madbak, Katherine Parikh, Marie Crandall
Nearly 3 million patients are hospitalized every year for emergent gastrointestinal (GI) surgical problems and nearly one third of those will require surgery. This article reviews the scope of GI surgical emergencies within the context of emergency general surgery (EGS), costs of care, overview of several common GI surgical problems, and traditional and emerging treatment modalities. This article also argues for ongoing work in the area of risk assessment for EGS, and describes quality metrics as well as outcomes of care for these patients...
October 15, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Mélissa Roy, Julie A Perry, Karen M Cross
The objective of this article is to convey the importance of nutrition in plastic surgery, to offer possible outpatient nutritional interventions within the surgical care setting, and to guide the plastic surgeon in integrating nutrition as a key practice enhancement strategy for the care of wound patients and beyond. The impact of nutritional status on surgical outcomes is well recognized. Malnutrition is very frequent among the hospitalized patient population and up to 1 in 4 plastic surgery outpatient is at risk for malnutrition...
August 2018: Plastic and Reconstructive Surgery. Global Open
Hui-Shan Lin, Rebecca L McBride, Ruth E Hubbard
Frailty is a state of decreased physiologic reserve and resistance to stressors. Its prevalence increases with age and is estimated to be 26% in those aged above 85 years. As the population ages, frailty will be increasingly seen in surgical patients receiving anesthesia. Here, we evaluate the instruments which have been developed and validated for measuring frailty in surgical patients and summarize frailty tools used in 110 studies linking frailty status with adverse outcomes post-surgery. Frail older people are vulnerable to geriatric syndromes, and complications such as postoperative cognitive dysfunction and delirium are explored...
2018: Local and Regional Anesthesia
Matthew D Ingham, Richard J Lee, Dhara MacDermed, Aria F Olumi
INTRODUCTION: As the transgender patient population continues to increase, urologists and other providers who treat genitourinary malignancies will increasingly encounter cases of prostate cancer in transgender women. Little exists in the current literature to help summarize the challenges and opportunities which face this unique patient population. Similarly, little exists to provide guidance on how we may best diagnose, manage, and follow transgender women diagnosed with prostate cancer...
October 12, 2018: Urologic Oncology
V I Ganiukov, R S Tarasov, I E Vereshchagin, O A Nagirniak, L S Barbarash
The authors carried out comparative assessment of in-hospital outcomes of transcatheter aortic valve implantation (TAVI) and «open» prosthetic repair of the aortic valve. The main criterion for inclusion into the study was the presence of indications for surgical correction of an isolated defect of the aortic valve (AV). Group One comprised 11 patients subjected to TAVI and Group Two (comparison group) consisted of 23 patients undergoing «open» prosthetic repair of the AV. There were no statistically significant between-group differences by the main parameters evaluated...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Oren M Rotman, Matteo Bianchi, Ram P Ghosh, Brandon Kovarovic, Danny Bluestein
Transcatheter aortic valve replacement (TAVR) has emerged as an effective minimally-invasive alternative to surgical valve replacement in medium- to high-risk, elderly patients with calcific aortic valve disease and severe aortic stenosis. The rapid growth of the TAVR devices market has led to a high variety of designs, each aiming to address persistent complications associated with TAVR valves that may hamper the anticipated expansion of TAVR utility. Areas Covered: Here we outline the challenges and the technical demands that TAVR devices need to address for achieving the desired expansion, and review design aspects of selected, latest generation, TAVR valves of both clinically-used and investigational devices...
October 15, 2018: Expert Review of Medical Devices
Yas Sanaiha, Ryan Ou, Gianna Ramos, Yen-Yi Juo, Richard J Shemin, Peyman Benharash
BACKGROUND: Because the rate of rehospitalization after major cardiac surgery has been reported up to 22%, an investigation of potential modifiable elements in the discharge process has led our group to evaluate whether the day of discharge affects readmission performance. METHODS: Our institutional Society of Thoracic Surgeons registry was used to identify all adult patients undergoing elective cardiac operations from 2008 to 2016. Emergency, transplant, and mechanical assist patients were excluded...
October 1, 2018: Annals of Thoracic Surgery
Evan C Carlos, Chloe E Peters, Daniel A Wollin, Brenton B Winship, Leah G Davis, Jingqiu Li, Charles D Scales, Samuel H Eaton, Glenn M Preminger, Michael E Lipkin
PURPOSE: Emergency department(ED) visits after ureteroscopy(URS) are costly and inconvenient. To better understand those at risk, we aim to identify patient demographic, medical and surgical factors associated with 30-day ED presentation following URS for urolithiasis with particular attention paid to those with a history of a psychiatric diagnosis(PD). MATERIALS AND METHODS: We retrospectively reviewed 1576 cases on 1395 adults who underwent stone-related URS over 3 years at two hospitals...
October 11, 2018: Journal of Urology
Saleh Abdel-Kader, Massimo Sartelli, Fikri M Abu-Zidan
INTRODUCTION: The World Society of Emergency Surgery (WSES) has recently developed and validated a sepsis severity score for complicated intra-abdominal infections (cIAIs). We aimed to prospectively study the validity of this score in our local setting and compare it with global findings. METHODS: In a prospective study of 100 consecutive adult patients with cIAIs treated at Al-Ain Hospital, United Arab Emirates, from October 2014 to January 2016, we studied the demography of patients, disease, risk factors, WSES Sepsis Severity Score, management, hospital stay and mortality...
October 10, 2018: Singapore Medical Journal
Mücahit Harmankaya, Jakob Ohm Oreskov, Jakob Burcharth, Ismail Gögenur
BACKGROUND: Patients undergoing major open emergency abdominal surgery experience high morbidity and mortality rates and often have sepsis at admission. The purpose of this study was to evaluate the association between antibiotic timing and in-hospital outcomes such as complications, need for reoperation, length of stay, and 30-day mortality. METHODS: This retrospective observational cohort study was conducted between January 2010 and December 2015 including patients that were triaged through the emergency department for subsequent major open abdominal surgery...
October 11, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Li-Yao Cong, You-Jin Choi, Kyung-Seok Hu, Tanvaa Tansatit, Hee-Jin Kim
BACKGROUND: During periorbital noninvasive and surgical procedures there is the risk of iatrogenic injury to the emerging point of the ophthalmic artery. This study aimed to determine the three-dimensional location of the emerging point of the ophthalmic artery and to provide clinicians with anatomic information that would help them to avoid associated complications. METHODS: Seventeen hemifaces of the emerging point of the ophthalmic artery from 10 Korean and 7 Thai cadavers were dissected and scanned by a three-dimensional scanner...
October 9, 2018: Plastic and Reconstructive Surgery
Michelle A Wyatt, Alessandra J Ainsworth, Stephanie R DeJong, Adela G Cope, Margaret E Long
OBJECTIVE: Preoperative evaluation for pregnancy at our institution lacked standardization among individual health care providers and surgical services. This pilot project aimed to improve assessment for pregnancy before scheduled outpatient gynecologic surgical procedures. The Pregnancy Reasonably Excluded Guide incorporates historic, evidence-based criteria to facilitate identification of patients with a higher chance of pregnancy. METHODS: We retrospectively reviewed documentation for women undergoing gynecologic surgery at an outpatient surgical center from March through September 2016, before and after implementation of the pregnancy assessment protocol...
October 5, 2018: Obstetrics and Gynecology
Charles E Edmiston, Maureen Spencer, David Leaper
A surgical site infection (SSI) can occur at several anatomic sites related to a surgical procedure: Superficial or deep incisional or organ/space. The SSIs are the leading cause of health-care-associated infection (HAI) in industrialized Western nations. Patients in whom an SSI develops require longer hospitalization, incur significantly greater treatment costs and reduction in quality of life, and after selective surgical procedures experience higher mortality rates. Effective infection prevention and control requires the concept of the SSI care bundle, which is composed of a defined number of evidence-based interventional strategies, because of the many risk factors that can contribute to the development of an SSI...
October 9, 2018: Surgical Infections
Adrian A Coleoglou Centeno, Christopher B Horn, Rohit K Rasane, Jose A Aldana, Qiao Zhang, Kelly M Bochicchio, Grant V Bochicchio, Obeid N Ilahi
BACKGROUND: Clostridium difficile infection (CDI) is an important surgical complication. Emergency general surgery (EGS) is a developing area of the acute care surgical practice. Few studies evaluating the incidence and risk factors of CDI in this patient population are available. PATIENTS AND METHODS: A prospectively maintained Acute and Critical Care Surgery registry spanning from 2008 to 2015 was queried for cases of operative EGS with clinical suspicion of CDI post-operatively...
October 9, 2018: Surgical Infections
Izabela Leahy, Connor Johnson, Steven J Staffa, Reza Rahbar, Lynne R Ferrari
BACKGROUND: The Pediatric Perioperative Surgical Home (PPSH) model is an integrative care model designed to provide better patient care and value by shifting focus from the patient encounter level to the overarching surgical episode of care. So far, no PPSH model has targeted a complex airway disorder. It was hypothesized that the development of a PPSH for laryngeal cleft repair would reduce the high rates of postoperative resource utilization observed in this population. METHODS: Institutional review board approval was obtained for the purpose of data collection and analysis...
October 8, 2018: Anesthesia and Analgesia
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