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Preoperative optimization

Chris Durkin, Travis Schisler, Jens Lohser
PURPOSE OF REVIEW: Despite marked improvements in perioperative outcomes, esophagectomy continues to be a high-risk operation associated with significant morbidity and mortality. Progress has been achieved through evidence-based changes in preoperative optimization, intraoperative ventilation strategies, fluid therapy, and analgesia, as well as expedited postoperative recovery pathways. This review will summarize the recent literature on the anesthetic management of patients undergoing esophageal resection...
October 18, 2016: Current Opinion in Anaesthesiology
Gen Sugawara, Yukihiro Yokoyama, Tomoki Ebata, Takashi Mizuno, Tetsuya Yagi, Masahiko Ando, Masato Nagino
OBJECTIVE: To evaluate the optimal duration of antimicrobial prophylaxis in patients undergoing "complicated"' major hepatectomy with extrahepatic bile duct resection. BACKGROUND: To date, 4 randomized controlled trials (RCTs) have assessed the duration of antimicrobial prophylaxis after hepatectomy. However, all of these previous studies involved only "simple" hepatectomy without extrahepatic bile duct resection. METHODS: Patients with suspected hilar obstruction scheduled to undergo complicated hepatectomy after biliary drainage were randomized to 2-day (antibiotic treatment on days 1 and 2) or 4-day (on days 1 to 4) groups...
October 17, 2016: Annals of Surgery
Giovanni Filardo, Gorav Ailawadi, Benjamin D Pollock, Briget da Graca, Danielle M Sass, Teresa K Phan, Debbie E Montenegro, Vinod Thourani, Ralph Damiano
BACKGROUND: New-onset atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) is associated with increased morbidity and poorer long-term survival. Although many studies show differences in outcome in women versus men after CABG, little is known about the sex-specific incidence and characteristics of post-CABG AF. METHODS AND RESULTS: Overall, 11 236 consecutive patients without preoperative AF underwent isolated CABG from 2002 to 2010 at 4 US academic medical centers and 1 high-volume specialty cardiac hospital...
October 18, 2016: Circulation. Cardiovascular Quality and Outcomes
Rachel S Bronheim, Eric K Oermann, Samuel K Cho, John M Caridi
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To identify associations between abnormal coagulation profile and postoperative morbidity and mortality in patients undergoing posterior lumbar fusion (PLF). SUMMARY OF BACKGROUND DATA: The literature suggests that abnormal coagulation profile is associated with postoperative complications, notably the need for blood transfusion. However, there is little research that directly addresses the influence of coagulation profile on postoperative complications following PLF...
October 17, 2016: Spine
Tae Suk Oh, Woo Shik Jeong, Taik Jin Chang, Kyung S Koh, Jong Woo Choi
BACKGROUND: It is difficult to restore original orbital contours because of their complex 3-dimensional structure. Moreover, slight implant malpositioning can result in enophthalmos or other complications. The authors describe our experience of using individualized prebent titanium-Medpor mesh implants and stereolithographic modeling in a series of patients who underwent orbital wall reconstruction. METHODS: A consecutive series of 104 patients with orbital fractures received computer simulation-designed prebent titanium-Medpor mesh implants insertion...
October 14, 2016: Journal of Craniofacial Surgery
Miha Vodičar, Robert Košak, Rok Vengust
PURPOSE: Presentation of a case series (10 patients) with surgical treatment of symptomatic anterior cervical osteophytes, a review of the latest literature and discussion of surgical methods. OBJECTIVE: To present our results of the surgical treatment and compare them with the existing literature. On the basis of the gathered data, we aim to propose an optimal choice of surgical treatment. SUMMARY OF BACKGROUND DATA: Anterior cervical osteophytes rarely cause symptoms that require surgical treatment, which disables bigger cohort analysis...
November 2016: Clinical Spine Surgery
Wilton A van Klei, Judith A R van Waes, Wietze Pasma, Teus H Kappen, Leo van Wolfswinkel, Linda M Peelen, Cor J Kalkman
BACKGROUND: For outcomes research where changes in intraoperative blood pressure are a possible causative factor, it is important to determine an appropriate source for a reference value. We studied to what extent preinduction blood pressure values in the operating room differ from those obtained during preoperative evaluation outside the operating room. METHODS: Cohort study including 4408 patients aged 60 years or older undergoing noncardiac surgery. The outcome was the difference between the preinduction mean blood pressure (MBP) and the MBP obtained during preoperative evaluation...
October 11, 2016: Anesthesia and Analgesia
Ivana Burazor, Stamenko Susak
OBJECTIVE: After stent or bypass surgery blood pressure (BP) can go up for multiple reasons among which are: stress and tense of the patient unsure about the future, the pain of the cut and because some of the blood pressure medication, which the patient was receiving preoperatively may get withdrawn post operatively, thereby leading to shooting up the BP. In certain patients, BP actually comes down after surgery and returns back to the pre-operative levels 4 to 6 weeks down the track...
September 2016: Journal of Hypertension
Meg H Zeller, Sanita Hunsaker, Carmen Mikhail, Jennifer Reiter-Purtill, Mary Beth McCullough, Beth Garland, Heather Austin, Gia Washington, Amy Baughcum, Dana Rofey, Kevin Smith
OBJECTIVE: To comprehensively assess family characteristics of adolescents with severe obesity and whether family factors impact weight loss outcomes following weight loss surgery (WLS). METHODS: Multisite prospective data from 138 adolescents undergoing WLS and primary caregivers (adolescent: Mage  = 16.9; MBMI = 51.5 kg/m(2) ; caregiver: Mage  = 44.5; 93% female) and 83 nonsurgical comparators (NSComp: adolescent: Mage  = 16.1; MBMI = 46.9 kg/m(2) ; caregiver: Mage  = 43...
October 18, 2016: Obesity
John C Kubasiak, Mackenzie Landin, Scott Schimpke, Jennifer Poirier, Jonathan A Myers, Keith W Millikan, Minh B Luu
INTRODUCTION: Tobacco smoking is a known risk factor for complications after major surgical procedures. The full effect of tobacco use on these complications has not been studied over large populations for ventral hernia repairs. This effect is more important as the preoperative conditioning, and optimization of patients is adopted. We sought to use the prospectively collected ACS-NSQIP dataset to evaluate respiratory and infectious complications for patients undergoing both laparoscopic and open ventral hernia repairs...
October 17, 2016: Surgical Endoscopy
Ke Jiang, Jianyong Lei, Wenjie Chen, Yanping Gong, Han Luo, Zhihui Li, Rixiang Gong, Jingqiang Zhu
The preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are known to be prognostic factors in several cancers. However, no previous investigation has been performed to evaluate the significance of the NLR and PLR in medullary thyroid carcinoma (MTC).The aim of this study was to identify the ability of the preoperative NLR or PLR to predict lymph node metastasis and recurrence in patients with MTC. Data from all patients with MTC who had undergone surgery at our institution from May 2009 to May 2016 were retrospectively evaluated...
October 2016: Medicine (Baltimore)
Stephen Choi, Turlough O'Hare, Jeffrey Gollish, James E Paul, Hans Kreder, Kevin E Thorpe, Joel D Katz, Muhammad Mamdani, Peter Moisiuk, Colin J McCartney
BACKGROUND: This randomized trial compared (1) continuous femoral nerve block (cFNB), (2) single femoral nerve block (sFNB), and (3) local infiltration analgesia (LIA) with respect to analgesic and functional outcomes after primary tricompartmental knee arthroplasty (TKA). METHODS: One hundred twenty patients undergoing primary tricompartmental knee arthroplasty were randomly assigned to 1 of 3 interventions for postoperative analgesia: (1) cFNB-preoperative bolus of ropivacaine 0...
October 3, 2016: Anesthesia and Analgesia
Zhongmin Wang, Yuhao Liu, Yu Xu, Chuanyu Gao, Yan Chen, Hongxing Luo
BACKGROUND: WE AIMED TO PROSPECTIVELY EVALUATE THE: use of 3-dimensional printing (3DP) for the percutaneous transcatheter closure of a secundum atrial septal defect (ASD) with rim deficiency less than 5 mm. METHODS: Patients with ASD were scanned using multi-slice computed tomography to acquire raw data for virtual 3DP reconstruction models. Different ASD occluders were tried on the 3DP models to select the optimal size for intraoperative use. The patients were followed up 1 month postoperatively, and 3DP models were again manufactured to observe the operative effects...
October 17, 2016: Cardiology Journal
Yuzo Nagai, Sinsuke Kazama, Daisuke Yamada, Takuya Miyagawa, Koji Murono, Koji Yasuda, Takeshi Nishikawa, Toshiaki Tanaka, Tomomichi Kiyomatsu, Keisuke Hata, Kazushige Kawai, Yuri Masui, Hiroaki Nozawa, Hironori Yamaguchi, Soichiro Ishihara, Takafumi Kadono, Toshiaki Watanabe
Treatment of perianal and vulvar extramammary Paget disease (EMPD), rare intraepithelial malignancies, is often challenging because of its potential to spread into the anal canal. However, there is still no consensus regarding the optimal resection margin within the anal canal. Between 2004 and 2014, six patients (three with perianal EMPD and three with vulvar EMPD) in which the spread of Paget cells into the anal canal was highly suspected were referred to our department. To evaluate the disease extent within the anal canal, preoperative mapping biopsy of the anal canal was performed in five out of six patients...
October 2016: Annals of Dermatology
Elizabeth B Gausden, Alexander B Christ, Stephen J Warner, Ashley Levack, Andrew Nellestein, Dean G Lorich
INTRODUCTION: The optimal treatment of humeral shaft fractures continues to be debated. In the current investigation, we sought to determine the clinical and radiographic outcomes following the plate fixation of humeral shaft fractures utilizing the triceps-sparing posterior approach. MATERIALS AND METHODS: A retrospective review identified a consecutive series of 66 humeral shaft fractures (OTA 12-A, 12-B, or 12-C) treated with dual plate fixation via a posterior, triceps-sparing approach between 2005 and 2014 by a single surgeon...
October 15, 2016: Archives of Orthopaedic and Trauma Surgery
Kei Mizuno, Takahiro Inoue, Hidefumi Kinoshita, Toshifumi Yano, Hiroaki Kawanishi, Hideki Kanda, Naoki Terada, Takashi Kobayashi, Tomomi Kamba, Yoshiki Mikami, Taizo Shiraishi, Yoshiko Uemura, Yukihiro Imai, Gen Honjo, Tomoyuki Shirase, Kazuhiro Okumura, Mutsushi Kawakita, Keiji Ogura, Yoshiki Sugimura, Tadashi Matsuda, Osamu Ogawa
OBJECTIVE: Active surveillance has emerged as an alternative to immediate treatment in men with favorable-risk prostate cancer; however, consensus about defining the appropriate candidates is still lacking. To examine the factors predicting unfavorable pathology among active surveillance candidates, we assessed low-risk radical prostatectomy specimens. METHODS: This retrospective study included 1753 men who had undergone radical prostatectomy at six independent institutions in Japan from 2005 to 2011...
October 15, 2016: Japanese Journal of Clinical Oncology
Kimona Issa, Todd P Pierce, Steven F Harwin, Anthony J Scillia, Anthony Festa, Michael A Mont
BACKGROUND: HIV is prevalent worldwide and numerous patients with this diagnosis ultimately may become candidates for TKA. Although some studies have suggested that complications are more common in patients with HIV who undergo TKA, these studies largely were done before the contemporary era of HIV management; moreover, it is unclear whether patients with HIV achieve lower patient-reported outcome scores or inferior implant survivorship. QUESTIONS/PURPOSES: We asked whether there were any differences in the outcomes of patients with HIV without hemophilia who undergo TKA compared with a matched control cohort in terms of: (1) patient-reported outcomes; (2) implant survivorship; and (3) complication rates...
October 14, 2016: Clinical Orthopaedics and related Research
Monica Jain, David L Krasne, Frederick R Singer, Armando E Giuliano
Parathyromatosis is a rare condition consisting of multiple nodules of benign hyperfunctioning parathyroid tissue scattered throughout the neck and superior mediastinum. As a potential cause of recurrent or persistent hyperparathyroidism, parathyromatosis is a challenging condition to diagnose and treat. The optimal evaluation and management of patients with parathyromatosis is not well established. The reported case involves a patient who was initially diagnosed with primary hyperparathyroidism. The diagnosis of Type 1 parathyromatosis was made after the patient developed recurrent hyperparathyroidism with hypercalcemia and osteoporosis 17 years after the initial operation and underwent two additional operations...
October 14, 2016: Endocrine
Leonardo Solaini, Bambang T Atmaja, Prabhu Arumugam, Robert R Hutchins, Ajit T Abraham, Satyajit Bhattacharya, Hemant M Kocher
BACKGROUND: We aim to evaluate the prognostic value of preoperative and postoperative inflammatory systems in patients who had undergone surgery for colorectal liver metastases, focusing our analysis on the role of C-reactive protein-to-albumin ratio (CAR) and Glasgow prognostic score (GPS). METHODS: A total of 194 patients were enrolled onto this study. Demographics, tumor-related variables, preoperative and postoperative (day 1) inflammatory variables were analyzed as potential prognostic factors...
October 11, 2016: International Journal of Surgery
Joseph C Dort, D Gregory Farwell, Merran Findlay, Gerhard F Huber, Paul Kerr, Melissa A Shea-Budgell, Christian Simon, Jeffrey Uppington, David Zygun, Olle Ljungqvist, Jeffrey Harris
Importance: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. Objective: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. Evidence Review: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic...
October 13, 2016: JAMA Otolaryngology—Head & Neck Surgery
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