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emergency surgical risk

Savannah Norman, Frank DeCicco, Jennifer Sampson, Ian M Fraser
OBJECTIVES: Ensure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpected inpatient deterioration. DESIGN: Quality improvement before-after unblinded trial. SETTING: 430-bed Canadian community teaching hospital. PARTICIPANTS: All admitted adult medical-surgical patients in a before-after 12-month interventional study...
December 14, 2018: BMJ Open
Skyler W Nielsen, Jayne R Stevens, Gregory J Stevens, Jagatkumar Patel, Robert L Eller
OBJECTIVES/HYPOTHESIS: Isolated case studies have shown improper sterilization or contamination of equipment from anesthesia carts can lead to transmission of disease and even death. Citing this literature, national accrediting agencies mandated all instruments in the otolaryngology airway carts at San Antonio Military Medical Center be packaged to prevent contamination. This study sought to determine the infection and safety implications of packaged airway cart instruments. STUDY DESIGN: Retrospective chart review...
December 13, 2018: Laryngoscope
Roger D Dias, Leon J Osterweil, Giuseppe Riccardi, Heather M Conboy, George S Avrunin, Steven J Yule, Jennifer M Gabany, David Arney, Marco A Zenati, Lori A Clarke, Julian M Goldman
In the surgical setting, team members constantly deal with a high-demand operative environment that requires simultaneously processing a large amount of information. In certain situations, high demands imposed by surgical tasks and other sources may exceed team member's cognitive capacity, leading to cognitive overload which may place patient safety at risk. In the present study, we describe a novel approach to integrate an objective measure of team member's cognitive load with procedural, behavioral and contextual data from real-life cardiac surgeries...
June 2018: ... IEEE International Inter-Disciplinary Conference on Cognitive Methods in Situation Awareness and Decision Support
Emma Altobelli, Leonardo Rapacchietta, Valerio F Profeta, Roberto Fagnano
Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have evaluated ultrasound screening for AAA providing evidence of a reduction in aneurysm-related mortality in the screened population. The aim of our study was to perform a systematic review and meta-analysis of the risk factors for AAA. We conducted a systematic review of observational studies and we performed a meta-analysis that evaluated the following risk factors: gender, smoking habits, hypertension, coronary artery disease and family history of AAA...
December 10, 2018: International Journal of Environmental Research and Public Health
Chul Seung Lee, Min Ki Kim
RATIONALE: Complete small bowel obstruction (SBO) is a common surgical emergency often resulting from adhesive bands installed after a surgical procedure. However, SBO caused by surgical staples used in a previous operation is unusual. Herein, we report a rare case of adhesive ileus induced by surgical staples. PATIENT'S CONCERNS: A 58-year-old woman visited our Emergency Department with right lower quadrant (RLQ) pain and vomiting. The patient had undergone laparoscopic total hysterectomy with the Endo GIA stapler for uterine myoma 6 years prior...
December 2018: Medicine (Baltimore)
Latifa Merzougui, Nedia Marwen, Hajer Hannachi, Massoudi Asma, Olfa Ben Elhaj, Manssouri Waddah, Ridha Fatnassi
INTRODUCTION: Surgical site infection (SSI) is a major health concern and is one of the most common complications following caesarean section, with an incidence of 3%-15%. With the worldwide increase in caesarean section rates, the incidence of SSI is expected to increase in parallel. This study was designed to estimate the incidence and determine the risk factors of SSI after caesarean section in an Obstetrics and Gynaecology department in the Kairouan region in Tunisia. METHODS: A prospective cohort study of all patients who delivered by caesarean section between December 2015 and February 2016 was conducted in the Kairouan Obstetrics and Gynaecology department...
May 2018: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
Ann-Kathrin Lederer, Dominic Haffa, Verena Martini, Roman Huber, Frank Makowiec, Stefan Fichtner-Feigl, Lampros Kousoulas
BACKGROUND: Due to the increasing number of patients after kidney transplantation, elective and emergency surgery of transplanted patients is becoming a relevant challenge in clinical routine. The current data on complication rate of patients after kidney transplantation, which must undergo another elective or emergency abdominal surgery, is inhomogeneous. Therefore, the aim of our study was to evaluate the outcome of renal transplant patients undergoing abdominal and abdominal wall surgery...
December 9, 2018: International Journal of Surgery
Luis Enrique Becerra Coral, Lorena Natalia Gomez Ceron, Adriana Isabel Delgado Bravo
Peritonitis is one of the main complications of abdominal emergencies. Laparoscopy serves both for the diagnostic and therapeutic management of the acute abdomen; in expert hands the morbimortality of this method is minimal. OBJECTIVE: The objective is to verify the efficacy of laparoscopy in patients with secondary peritonitis performing a single surgery without the need for reinterventions, ensuring the least damage of the abdominal wall, avoiding laparotomy. MATERIAL AND METHODS: Retrospective study included patients with final diagnosis of peritonitis and managed with laparoscopic technique, covering a period from May 2011 to July 2016, admitted to Clínica Nuestra Señora de Fátima, Pasto, Colombia...
July 2018: Revista de Gastroenterología del Perú: órgano Oficial de la Sociedad de Gastroenterología del Perú
Alex Ramirez, Sanjay Mohan, Rebecca Miller, Dmitry Tumin, Joshua C Uffman, Joseph D Tobias
PURPOSE: We prospectively investigated contamination of high-contact surfaces in the operating room (OR) using adenosine triphosphate (ATP) monitoring. We tested whether contamination would increase from morning (AM) to afternoon (PM), despite cleaning between cases. Second, we compared the degree of OR contamination to non-OR control sites. METHODS: ORs with high case volumes were selected for the study. Ten sites in each OR were swabbed using the AccuPoint® HC ATP Sanitation Monitoring device, which provided a numerical measure of contamination (relative light units, RLUs)...
December 11, 2018: Journal of Anesthesia
Kathrin Heldmaier, Christian Stoppe, Andreas Goetzenich, Ann-Christina Foldenauer, Rachat Zayat, Thomas Breuer, Gereon Schälte
Background: Aortic valve stenosis has gained increasingly more importance due to its high prevalence in elderly people. More than two decades ago, transcatheter aortic valve replacement emerged for patients who were denied surgery, and its noninferiority has been demonstrated in numerous studies. Oxidative stress has generated great interest because of its sensitivity to cell damage and the possibility of offering early hints of clinical outcomes. The aim of the present study was to investigate whether there is a significant difference between transcatheter (TAVR) or surgical aortic valve replacement (SAVR) in terms of the changes in oxidation-reduction potential (ORP) and antioxidant capacity...
2018: BioMed Research International
Anders Schack, Jakob Ohm Oreskov, Sarah Ekeloef, Thorsten Brodersen, Sisse Rye Ostrowski, Ismail Gögenur, Jakob Burcharth
BACKGROUND: ABO dependent variation in von Willebrand factor (vWF) and factor VIII have an impact on hemostasis. Several contradictory studies have investigated the influence of ABO blood type in surgical hemorrhage. Emergency surgery is associated with an increased risk of perioperative hemorrhage leading to inferior clinical outcomes. The aim of this study was to investigate if patients with blood type O received more transfusions with blood components compared with non-O patients after major emergency abdominal surgery...
December 10, 2018: Transfusion
Usman Riaz, Ishraq Shabib, Waseem Haider
Magnesium (Mg) has emerged as an ideal alternative to the permanent implant materials owing to its enhanced properties such as biodegradation, better mechanical strengths than polymeric biodegradable materials and biocompatibility. It has been under investigation as an implant material both in cardiovascular and orthopedic applications. The use of Mg as an implant material reduces the risk of long-term incompatible interaction of implant with tissues and eliminates the second surgical procedure to remove the implant, thus minimizes the complications...
December 7, 2018: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Ralph F Staerkle, Ilan Rosenblum, Ferdinand Köckerling, Daniela Adolf, Reinhard Bittner, Philipp Kirchhoff, Frank S Lehmann, Henry Hoffmann, Philippe M Glauser
BACKGROUND: Paraesophageal hernias (PEH) tend to occur in elderly patients and the assumed higher morbidity of PEH repair may dissuade clinicians from seeking a surgical solution. On the other hand, the mortality rate for emergency repairs shows a sevenfold increase compared to elective repairs. This analysis evaluates the complication rates after elective PEH repair in patients 80 years and older in comparison with younger patients. METHODS: In total, 3209 patients with PEH were recorded in the Herniamed Registry between September 1, 2009 and January 5, 2018...
December 10, 2018: Surgical Endoscopy
Victor Vlad Costan, Camelia Tamaş, Nicolaie Dobrin, Dan Alexandru Costache, Manuela Ciocoiu
Basal cell carcinoma (BCC) is the most common type of cancer located in the periocular area. We will present the clinical case of a 63-year-old male patient who was admitted to the 2nd Clinic of Neurosurgery, "Prof. Dr. Nicolae Oblu" Emergency Clinical Hospital, Iaşi, Romania, for an ulcerated tumor of about 0.8×0.7 cm in diameter with rolled edges and central necrosis in the upper eyelid with orbital invasion. According to the patient's personal history, he also underwent Cortisone treatment for dermatomyositis...
2018: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
Ci Huang, Mun-Kun Hong, Tang-Yuan Chu, Dah-Ching Ding
Background: Adnexal torsion is a gynecologic emergency that requires surgical treatment. In this study, we reviewed the surgical outcomes of women with adnexal torsion in eastern Taiwan (Hualien county, area 4,629 km2 , 330,000 residents). Methods: This retrospective study included 42 women diagnosed with surgically-proven adnexal torsion from January 1, 2010, to September 31, 2015. We compared the symptoms, objective findings, and surgical outcomes of patients who underwent laparotomy or laparoscopy...
2018: PeerJ
K V Kochkina, A V Sidorenko, A V Myznikov, G A Usik, A A Shtark, T A Kochkina, A V Pustovoitov, A V Protopopov
A ruptured thoracoabdominal aortic aneurysm is an urgent situation requiring emergency surgery during which it is necessary to decrease the scope of the intervention in a patient at an extremely high surgical risk. A combination of surgical and endovascular techniques makes it possible to minimize surgical injury, blood loss, to shorten the duration of internal organs ischaemia, to reduce the risk of paraplegia. Presented herein are the results of emergency hybrid intervention for a ruptured thoracoabdominal aortic aneurysm, accompanied and followed by description of the technical aspects of performing the surgical and endovascular stages...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Shuyan Wei, Charles Green, Lillian S Kao, Brandy B Padilla-Jones, Van T T Truong, Charles E Wade, John A Harvin
BACKGROUND: Organ/space surgical site infection (OS-SSI) develops frequently after trauma laparotomies and is associated with significant morbidity. No valid model exists to accurately risk-stratify the probability of OS-SSI development after emergent laparotomy. Risk stratification for OS-SSI in these patients could guide promising, but unproven, interventions for OS-SSI prevention, such as more frequent dosing of intraoperative antibiotics or direct peritoneal resuscitation.We hypothesize that in trauma patients who undergo emergent laparotomy, probability of OS-SSI can be accurately estimated using patient data available during the index operation...
December 6, 2018: Journal of Trauma and Acute Care Surgery
Albert Ariza-Solé, José C Sánchez-Salado, Fabrizio Sbraga, Daniel Ortiz, José González-Costello, Arnau Blasco-Lucas, Oriol Alegre, David Toral, Victòria Lorente, Eva Santafosta, Jacobo Toscano, Andrea Izquierdo, Albert Miralles, Ángel Cequier
BACKGROUND: Current guidelines recommend emergency surgical correction in patients with post infarction ventricular septal rupture (PIVSR), but patients with multiorgan failure are commonly managed conservatively because of high surgical risk. We assessed characteristics and outcomes of operated PIVSR patients with or without the use of short-term ventricular assist devices (ST-VADs). We also assessed the impact of a ST-VAD on the performance of surgery. METHODS: We retrospectively analysed all consecutive patients with PIVSR between January 2004 and May 2017...
December 10, 2018: European Heart Journal. Acute Cardiovascular Care
E Russo, D R Potenza, M Casella, R Massaro, G Russo, M Braccio, A Dello Russo, M Cassese
Transcather aortic valve implantation (TAVI) has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis who are at high surgical risk. Recently, outcomes after TAVI have improved significantly and TAVI has emerged as a qualified alternative to surgical aortic valve replacement in the treatment of intermediate risk patients and greater adoption of this procedure is to be expected in a wider patients population, including younger patients and low surgical risk patients...
December 4, 2018: Current Cardiology Reviews
Yara F Alhamdani, Hisham A Rizk, Mohammed R Algethami, Asma M Algarawi, Roia H Albadawi, Sofana N Faqih, Elaf H Ahmed, Ohud J Abukammas
Introduction: Acute Appendicitis is the most common emergent abdominal surgery worldwide. diagnosis based on clinical assessment, laboratory and radiological investigations and appendectomy is the treatment of choice. Removing a normal appendix is a relatively common surgical issue, defined as negative appendectomy (NA). Multiple risk factors contribute to NA; female gender, normal WBC, normal CRP count, and CT scan unavailability. However, recently NA is decreasing in incidence after CT scan and Alvarado scoring...
October 2018: Materia Socio-medica
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