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Preoperative risk Pulmonary

Jakob Wittenstein, Lorenzo Ball, Paolo Pelosi, Marcelo Gama de Abreu
PURPOSE OF REVIEW: Patients undergoing thoracic surgery are at high risk for pulmonary and extra pulmonary complications, and may develop impairment of gas exchange during surgery and in the postoperative period. This review focuses on the potential benefits of high-flow nasal cannula (HFNC) oxygen therapy in those patients. RECENT FINDINGS: HFNC oxygen therapy can be used pre, intra and postoperatively. However, evidence for the use of HFNC oxygen therapy is still limited...
December 12, 2018: Current Opinion in Anaesthesiology
Hirokazu Inoue, Hideaki Watanabe, Hitoshi Okami, Atsushi Kimura, Katsushi Takeshita
Background: This prospective cohort study investigated the rate of venous thromboembolism (VTE) before and after spine surgery as determined with use of indirect multidetector computed tomography (MDCT). Methods: We performed a prospective study of 105 patients (36 women and 69 men ranging in age from 38 to 88 years) undergoing spine surgery at 2 institutions. Indirect MDCT was performed before and 3 days after surgery. Patients with a history of dialysis or drug allergy to contrast medium were excluded...
September 25, 2018: JB & JS open access
Richard Templeton, Donna Greenhalgh
PURPOSE OF REVIEW: Lung resection provides the best outcome for patients with early stage lung cancer. However, lung cancer surgery carries a significant risk of perioperative complications. Patient risk may be reduced by addressing modifiable risk factors in the preoperative period. We review how this can be achieved through preoperative rehabilitation pathways. RECENT FINDINGS: Cardiorespiratory fitness is an independent predictor of survival for nonsmall cell cancer...
December 6, 2018: Current Opinion in Anaesthesiology
Eduardo Chacon, Valery Vilchez, Pedro Eman, Francesc Marti, Gareth Morris-Stiff, Adam Dugan, Lilia Turcios, Roberto Gedaly
OBJECTIVE: To determine predictors of critical care complications (CCC) in patients undergoing hepatectomy. METHODS: All hepatectomy patients in NSQIP from 2012 to 2016 were analyzed. CCC included prolonged ventilation (>48 h), sepsis/septic shock, renal failure/insufficiency, cardiac arrest/AMI and pulmonary embolism. RESULTS: A total of 21,443 patients underwent hepatectomy during the study period. Overall rate of CCC was 11%, with the most common being sepsis/septic shock (6...
November 30, 2018: American Journal of Surgery
Jeffrey J Siracuse, Alik Farber, Thomas W Cheng, Stephen J Raulli, Douglas W Jones, Jeffrey A Kalish, Matthew R Smeds, Denis Rybin, Marc L Schermerhorn
OBJECTIVE: Ipsilateral antegrade access (AA) is an alternative access option for contralateral retrograde access (RA) in treating infrainguinal occlusive disease. Our goal was to assess whether AA is associated with higher access site complications. METHODS: The Vascular Quality Initiative database was searched from 2010 to 2017 for all infrainguinal peripheral vascular interventions. Cases without access through the common femoral artery or those with multiple accesses were excluded...
December 4, 2018: Journal of Vascular Surgery
Anita Nguyen, Hartzell V Schaff, Martin D Abel, S Allen Luis, Brian D Lahr, Thorvardur R Halfdanarson, Heidi M Connolly
OBJECTIVE: Carcinoid heart disease is characterized by tricuspid valve regurgitation and varying degrees of pulmonary valve regurgitation or stenosis. Valve replacement procedures may be complicated by systemic effects of carcinoid syndrome, as well as hepatic dysfunction and right heart failure. This study was performed to identify factors that might be associated with improving early mortality rates and late outcomes. METHODS: Between November 1985 and January 2018, 240 adult patients underwent surgery for carcinoid heart disease at the Mayo Clinic...
October 3, 2018: Journal of Thoracic and Cardiovascular Surgery
Biniam Kidane, Daniel Cornejo Palma, Neal H Badner, Melissa Hamilton, Larissa Leydier, Dalilah Fortin, Richard I Inculet, Richard A Malthaner
BACKGROUND: Existing evidence regarding lung-protective ventilation (LPV) during one-lung ventilation (OLV) focuses on surrogate outcomes. Our objective was to assess whether an LPV protocol during OLV surgery is associated with reduced respiratory complications. MATERIALS AND METHODS: This was a matched control retrospective cohort study of patients undergoing pulmonary resection at a tertiary Canadian hospital. The experimental group (n = 50) was derived from primary data of two crossover RCTs, which utilized protocolized LPV strategies with varying levels of positive end-expiratory pressure and recruitment maneuvers...
February 2019: Journal of Surgical Research
Victoria Novoa Y Novoa, Sherif Shazly, Edward Araujo Júnior, Gabriele Tonni, Rodrigo Ruano
OBJECTIVES: To summarize current evidence on the use of tocolytic medications perioperatively for open prenatal repair of fetal myelomeningocele including tocolytic agent options, regimens, efficiency, and potential risks. METHODS: A search of Medline, Embase, and SCOPUS databases was conducted from inception to March 2017. Studies that described their tocolytic protocol, gestational age at delivery, perinatal outcomes were included. Studies that did not exclusively assessed fetal myelomeningocele or did not adequately endorse obstetric and neonatal outcomes were excluded...
December 10, 2018: Journal of Maternal-fetal & Neonatal Medicine
Michael J Chen, Abiram Bala, James I Huddleston, Stuart B Goodman, William J Maloney, Alistair J Aaronson, Derek F Amanatullah
INTRODUCTION: While statins have been found to reduce postoperative atrial fibrillation after cardiac surgery, little is known about their use in total hip arthroplasty (THA). This study investigated if statins would similarly reduce postoperative arrhythmias in patients undergoing THA. METHODS: We queried a large Medicare and private-payer database from 2005 to 2012 and identified 12,075 patients who were on a statin prior to THA. We then age and sex matched 34,446 non-statin users who underwent THA...
December 10, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Adam A Dalia, Scott Streckenbach, Mike Andrawes, Richard Channick, Cameron Wright, Michael Fitzsimons
Airway management during pulmonary thromboendarterectomy (PTE) can prove challenging, especially in the face of unexpected intraoperative pulmonary hemorrhage. Utilization of proper airway equipment on induction is crucial for the successful management of intraoperative pulmonary hemorrhage. Our case series describes the preoperative risk factors that can lead to intraoperative pulmonary hemorrhage, the preinduction airway equipment considerations for PTE, and the intraoperative management of pulmonary hemorrhage...
2018: Frontiers in Medicine
Huipeng Yin, Kun Wang, Yong Gao, Yukun Zhang, Wei Liu, Yu Song, Shuai Li, Shuhua Yang, Zengwu Shao, Cao Yang
BACKGROUND: Junction tuberculous spondylitis involves the stress transition zone of the spine and has a high risk of progression to kyphosis or paraplegia. Problems still exist with treatment for spinal junction tuberculosis. This study investigated the surgical approach and clinical outcomes of junction spinal tuberculosis. METHODS: From June 1998 to July 2014, 77 patients with tuberculous spondylitis were enrolled. All patients received 2-3 weeks of anti-tuberculous treatment preoperatively; treatment was prolonged for 2-3 months when active pulmonary tuberculosis was present...
December 6, 2018: Journal of Orthopaedic Surgery and Research
Andrew Davies, Wei Sheng Pang, Timothy Fowler, Ffion Dewi, Thomas Wright
Preoperative fasting is necessary to reduce the risk of regurgitation of gastric contents and pulmonary aspiration in patients undergoing general anaesthetic and procedural sedation. Excessive fasting is associated with metabolic, cardiovascular and gastrointestinal complications and patient discomfort. We aimed to reduce the fasting time for patients on the plastic surgery trauma list. Adult inpatients awaiting surgery were asked to complete a preoperative assessment sheet. Questions included the length of preoperative fasting, clarity of instructions and wellness scores...
2018: BMJ Open Quality
Ivy N Haskins, Lisbi Rivas, Tammy Ju, Ashlyn E Whitlock, Richard L Amdur, Anton N Sidawy, Paul P Lin, Khashayar Vaziri
BACKGROUND: Venous thromboembolism, including pulmonary embolism (PE) and deep venous thrombosis, is a leading cause of morbidity and mortality after bariatric surgery. Inferior vena cava filters (IVCFs) have been used as a method to reduce the incidence of clinically significant PEs after bariatric surgery. OBJECTIVES: To compare the incidence of postoperative PEs in patients with IVCFs with those in patients without IVCFs at the time of bariatric surgery. SETTING: American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program...
October 18, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Lucio Cagini, Gabriela Cardaioli, Marco Andolfi, Ketty Savino, Paolo Eusebi, Ilenia Corbelli, Simone Simoni, Jacopo Vannucci, Elisa Sacchini, Francesco Ripandelli, Alberto Matricardi, Francesco Puma
BACKGROUND: Patent foramen ovale (PFO) is present in up to 25% of the general population and is considered an irrelevant condition in healthy subjects. Here we sought to determine an association between the presence of an asymptomatic PFO at baseline and postoperative short-term adverse events in patients undergoing major pulmonary resection for lung cancer. As well, we evaluated for the rate of PFO after pulmonary resections. METHODS: This prospective, observational study assessed patients by transcranial doppler (TCD) with contrast at baseline and discharge...
November 30, 2018: Annals of Thoracic Surgery
Ashutosh Kaushal, Puneet Goyal, Sanjay Dhiraaj, Aarti Agarwal, Prabhat Kumar Singh
Objective: Identification of risk factors that might be responsible for postoperative hypoxaemia, in view of changing profile of surgical patients and better but more complex perioperative care nowadays. Methods: We conducted a prospective observational study that included patients aged 18-65 years, who underwent elective surgery and required general anaesthesia. Oxygen saturation was monitored before the induction in operating room and continued 72 hours post-surgery...
December 2018: Turkish Journal of Anaesthesiology and Reanimation
Erin Chang, Paul J Chung, Michael C Smith, Michael J Lee, Daniel J Gross, Elizabeth Kao, Gainosuke Sugiyama
BACKGROUND: With the population of octogenarians projected to increase fourfold by 2050, we sought to compare outcomes of laparoscopic versus open approach in octogenarians requiring surgery for adhesive small bowel obstruction (SBO). METHODS/MATERIALS AND METHODS: Using 2006-2015 American College of Surgeons National Surgical Quality Improvement Project, we identified patients aged ≥80 y who underwent emergency surgery within 1 d of admission for SBO. Risk variables of interest included age, sex, race, body mass index, preoperative sepsis, and American Society of Anesthesiologists (ASA) classification...
January 2019: Journal of Surgical Research
Jessica P Simons, Andres Schanzer, Julie M Flahive, Nicholas H Osborne, Joseph L Mills, Andrew W Bradbury, Michael S Conte
OBJECTIVE: Accurate survival prediction critically influences decision-making in caring for patients with chronic limb-threatening ischemia (CLTI). The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial demonstrated that in patients who survived >2 years, there was a significant advantage to infrainguinal bypass compared with endovascular intervention, which increased with time. Validated survival models for patients with CLTI are lacking. METHODS: The Vascular Quality Initiative was interrogated for patients who underwent infrainguinal bypass or endovascular intervention for CLTI (January 2003-February 2017)...
November 26, 2018: Journal of Vascular Surgery
Courtney A Penn, Neil S Kamdar, Daniel M Morgan, Ryan J Spencer, Shitanshu Uppal
OBJECTIVE: Returning home after surgery is a desirable patient-centered outcome associated with decreased costs compared to non-home discharge. Our objective was to develop a preoperative risk-scoring model predicting non-home discharge after surgery for gynecologic malignancy. METHODS: Women who underwent surgery involving hysterectomy for gynecologic malignancy from 2013 to 2015 were identified from the Michigan Surgical Quality Collaborative database. Patients were divided by discharge destination, and a multivariable logistic regression model was developed to create a nomogram to assign case-specific risk scores...
November 26, 2018: Gynecologic Oncology
Bolin Liu, Yuan Wang, Shujuan Liu, Tianzhi Zhao, Binfang Zhao, Xue Jiang, Lin Ye, Lanfu Zhao, Wenhai Lv, Yufu Zhang, Tao Zheng, Yafei Xue, Lei Chen, Long Chen, Yingxi Wu, Zhengmin Li, Jing Yan, Shasha Wang, Xude Sun, Guodong Gao, Yan Qu, Shiming He
OBJECT: The aim of this study was to evaluate the effect of preoperative oral carbohydrate loading versus fasting on the outcomes of patients undergoing elective craniotomy. METHODS: In a single-center randomized controlled study, 120 neurosurgical patients who were admitted for elective craniotomy were included and randomized into 2 groups: 58 patients received 400 mL of oral carbohydrate loading 2 h before surgery (intervention group), and 62 patients were fasting for 8 h prior to surgery as routine management (control group)...
November 17, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Ivan Ye, Ray Tang, Samuel J White, Zoe B Cheung, Samuel K Cho
OBJECTIVE: The purpose of this study was to identify predictors of 30-day postoperative pulmonary complications following open reduction and internal fixation (ORIF) of vertebral fractures. METHODS: We performed a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2014. Adult patients who underwent ORIF of vertebral fractures were included and divided into 2 groups based on the occurrence of 30-day postoperative pulmonary complications...
November 26, 2018: World Neurosurgery
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