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Perioperative assessment

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https://www.readbyqxmd.com/read/28433333/effects-of-hospital-safety-net-burden-and-hospital-volume-on-failure-to-rescue-after-open-abdominal-aortic-surgery
#1
Eric B Rosero, Girish P Joshi, Abu Minhajuddin, Carlos H Timaran, J Gregory Modrall
OBJECTIVE: Failure to rescue (FTR) is defined as the inability to rescue a patient from major perioperative complications, resulting in operative mortality. FTR is a known contributor to operative mortality after open abdominal aortic surgery. Understanding the causes of FTR is essential to designing interventions to improve perioperative outcomes. The objective of this study was to determine the relative contributions of hospital volume and safety-net burden (the proportion of uninsured and Medicaid-insured patients) to FTR...
April 19, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28433247/outpatient-laparoscopic-appendectomy-feasible-in-a-public-county-hospital
#2
David R Rosen, Kenji Inaba, Paul J Oh, Adam C Gutierrez, Aaron M Strumwasser, Subarna Biswas, Melody Cala, Glenn T Ault
BACKGROUND: Outpatient laparoscopic appendectomy is being used increasingly as a treatment option for acute, uncomplicated appendicitis. This was a prospective validation study in a large, urban, public safety-net hospital. STUDY DESIGN: From 2014 to 2016, all patients undergoing laparoscopic appendectomy for acute, uncomplicated appendicitis were enrolled in a prospective observational trial. Standard baseline perioperative practice (control group) was documented for 1 year...
March 13, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28432158/risk-score-for-cardiac-surgery-in-active-left-sided-infective-endocarditis
#3
Carmen Olmos, Isidre Vilacosta, Gilbert Habib, Luis Maroto, Cristina Fernández, Javier López, Cristina Sarriá, Erwan Salaun, Salvatore Di Stefano, Manuel Carnero, Sandrine Hubert, Carlos Ferrera, Gabriela Tirado, Afonso Freitas-Ferraz, Carmen Sáez, Javier Cobiella, Juan Bustamante-Munguira, Cristina Sánchez-Enrique, Pablo Elpidio García-Granja, Cecile Lavoute, Benjamin Obadia, David Vivas, Ángela Gutiérrez, José Alberto San Román
OBJECTIVE: To develop and validate a calculator to predict the risk of in-hospital mortality in patients with active infective endocarditis (IE) undergoing cardiac surgery. METHODS: Thousand two hundred and ninety-nine consecutive patients with IE were prospectively recruited (1996-2014) and retrospectively analysed. Left-sided patients who underwent cardiac surgery (n=671) form our study population and were randomised into development (n=424) and validation (n=247) samples...
April 21, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28431422/how-long-is-too-long-the-prespiked-intravenous-debate
#4
Jennifer L Stedman, Joel M Yarmush, Minal C Joshi, Sangeetha Kamath, Joseph Schianodicola
BACKGROUND: As the number of operative cases increases, there is a greater emphasis on reducing inefficiency while maintaining patient safety. Recently, the issue of prespiking intravenous (IV) bags was raised. No study has assessed whether the risk of infection is related to the length of time a sterile (IV) fluid bag has been spiked. After completion of a pilot study revealed no microbial growth within 24 hours of an IV spike, a larger formal study was undertaken to determine whether there was an increased infection risk within 4 hours of spiking an intravenous fluid bag...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28430694/iron-loading-exaggerates-the-inflammatory-response-to-the-toll-like-receptor-4-ligand-lipopolysaccharide-by-altering-mitochondrial-homeostasis
#5
Konrad Hoeft, Donald B Bloch, Jan A Graw, Rajeev Malhotra, Fumito Ichinose, Aranya Bagchi
BACKGROUND: Perioperative and critically ill patients are often exposed to iron (in the form of parenteral-iron administration or blood transfusion) and inflammatory stimuli, but the effects of iron loading on the inflammatory response are unclear. Recent data suggest that mitochondrial reactive oxygen species have an important role in the innate immune response and that increased mitochondrial reactive oxygen species production is a result of dysfunctional mitochondria. We tested the hypothesis that increased intracellular iron potentiates lipopolysaccharide-induced inflammation by increasing mitochondrial reactive oxygen species levels...
April 21, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28429925/robot-assisted-laparoendoscopic-single-site-versus-mini-laparoscopic-pyeloplasty-a-comparison-of-perioperative-functional-and-cosmetic-results
#6
Cristian Fiori, Riccardo Bertolo, Matteo Manfredi, Fabrizio Mele, Daniele Amparore, Giovanni Cattaneo, Ivano Morra, Roberto M Scarpa, Francesco Porpiglia
BACKGROUND: New approaches have been developed to further reduce the invasiveness of laparoscopic pyeloplasty (P) as treatment for uretero-pelvic junction obstruction (UPJO). Aim of the study was to compare perioperative, functional and cosmetic results of mini-laparoscopic (mL-P) versus robot-assisted laparoendoscopic single-site P (rLESS-P). METHODS: Since April 2009 to June 2010, 12 adult patients with primary UPJO, BMI<25 and no previous abdominal surgeries were enrolled undergoing mLP (3-mm instruments only)...
April 20, 2017: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
https://www.readbyqxmd.com/read/28427775/nonoperative-management-of-atypical-endometrial-hyperplasia-and-grade-1-endometrial-cancer-with-the-levonorgestrel-intrauterine-device-in-medically-ill-post-menopausal-women
#7
William D Baker, Stuart R Pierce, Anne M Mills, Paola A Gehrig, Linda R Duska
OBJECTIVE: To assess the endometrial response rates to treatment with the levonorgestrel intrauterine device in post-menopausal women with atypical hyperplasia/endometrial intraepithelial neoplasia and grade 1 endometrioid (AH/EC) endometrial carcinoma who are not surgical candidates. METHODS: Chart review was undertaken of patients with AH/EC who underwent levonorgestrel intrauterine device insertion by a gynecologic oncologist within two academic health systems between 2002 and 2013...
April 18, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28427403/preoperative-carbohydrate-load-and-intraoperatively-infused-omega-3-polyunsaturated-fatty-acids-positively-impact-nosocomial-morbidity-after-coronary-artery-bypass-grafting-a-double-blind-controlled-randomized-trial
#8
Gibran Roder Feguri, Paulo Ruiz Lúcio de Lima, Danilo de Cerqueira Borges, Laura Ramos Toledo, Larissa Nadaf Batista, Thaís Carvalho E Silva, Neuber José Segri, José Eduardo de Aguilar-Nascimento
BACKGROUND: A strategy of limited preoperative fasting, with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA), has seldom been tried in cardiovascular surgery. Brief fasting, followed by CHO intake 2 h before anesthesia, may improve recovery from CABG procedures and lower perioperative vasoactive drug requirements. Infusion of ω-3 PUFA may reduce occurrences of postoperative atrial fibrillation (POAF) and shorten hospital stays...
April 20, 2017: Nutrition Journal
https://www.readbyqxmd.com/read/28427002/incidental-posterior-mediastinal-paraganglioma-the-safe-approach-to-management-case-report
#9
Juan A Muñoz-Largacha, Roan J Glocker, Jacob Moalem, Michael J Singh, Virginia R Litle
INTRODUCTION: Paragangliomas are neuroendocrine tumors arising from chromaffin cells located in sympathetic paraganglia. Mediastinal paragangliomas are extremely rare and can be classified as functional or non-functional according to their ability for secreting catecholamines. Patients can be asymptomatic and the diagnosis is usually incidental. Complete surgical resection remains the standard of care for paragangliomas. PRESENTATION OF CASE: We present a 44-year-old woman with a functional mediastinal paraganglioma incidentally found during the perioperative imaging workup for a diagnosed breast carcinoma...
March 31, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28426259/the-sernbo-score-predicts-1-year-mortality-after-displaced-femoral-neck-fractures-treated-with-a-hip-arthroplasty
#10
Carl Mellner, Thomas Eisler, Johannes Börsbo, Cyrus Brodén, Per Morberg, Sebastian Mukka
Background and purpose - Displaced femoral neck fractures (FNFs) are associated with high rates of mortality during the first postoperative year. The Sernbo score (based on age, habitat, mobility, and mental state) can be used to stratify patients into groups with different 1-year mortality. We assessed this predictive ability in patients with a displaced FNF treated with a hemiarthroplasty or a total hip arthroplasty. Patients and methods - 292 patients (median age 83 (65-99) years, 68% female) with a displaced FNF were included in this prospective cohort study...
April 20, 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/28425822/association-of-hepatic-vein-lipiodol-tram-track-sign-during-transcatheter-arterial-chemoembolization-with-perioperative-death
#11
Hongwei Zhao, Fuquan Liu, Zhendong Yue, Lei Wang, Zhenhua Fan, Fuliang He
Objective To assess the relationship between the hepatic vein Lipiodol tram-track sign during transcatheter arterial chemoembolization (TACE) and perioperative death. Methods Patients treated for hepatic carcinoma at the Beijing Shijitan Hospital, Capital Medical University from January 2010 to December 2015 were retrospectively evaluated. The patients underwent hepatic TACE with Lipiodol. The incidence of the hepatic vein Lipiodol tram-track sign, prognosis, and possible risk factors were analyzed. Results A total of 5372 patients underwent hepatic TACE and had complete available intraoperative imaging data...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28425090/determinants-of-the-post-pericardiotomy-syndrome-a-systematic-review
#12
REVIEW
Dirk van Osch, Hendrik M Nathoe, Kirolos A Jacob, Pieter A Doevendans, Diederik van Dijk, Willem J Suyker, Jan M Dieleman
BACKGROUND: Post Pericardiotomy Syndrome (PPS) is a common complication following cardiac surgery, however the exact pathogenesis remains uncertain. Identifying risk factors of PPS might help to better understand the syndrome. The aim of this study was to provide an overview of existing literature around determinants of PPS in adult cardiac surgery patients. MATERIAL AND METHODS: Two independent investigators performed a systematic search in MEDLINE, EMBASE and the Cochrane Central Register...
April 20, 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28425054/can-a-three-component-prosthesis-be-used-for-conversion-of-painful-ankle-arthrodesis-to-total-ankle-replacement
#13
Markus Preis, Travis Bailey, Lucas S Marchand, Alexej Barg
BACKGROUND: In patients with painful ankle arthrodesis, the surgical treatment is challenging, and may include takedown of ankle arthrodesis and conversion to a total ankle replacement (TAR). This procedure is technically demanding given the altered anatomy after arthrodesis. Few studies have evaluated TAR in the setting of prior arthrodesis. QUESTIONS/PURPOSES: (1) What intraoperative and perioperative complications were observed in patients who underwent conversion of an ankle arthrodesis to a TAR? (2) Was durable fixation achieved at short term, and what was the alignment of the components? (3) What subsequent surgical procedures were performed, including revisions? (4) What improvements were observed in pain, tibiotalar range of motion (ROM), and quality of life? METHODS: Between January 2007 and December 2014, 18 patients with a painful ankle arthrodesis underwent conversion to TAR at our tertiary referral center...
April 19, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28424911/long-term-outcomes-of-endoscopic-resection-of-gastric-gists
#14
Changji Yu, Guobin Liao, Chaoqiang Fan, Jing Yu, Xubiao Nie, Shiming Yang, Jianying Bai
OBJECTIVE: Although the endoscopic treatment of gastric stromal tumors is a recently accepted therapy, the long-term outcomes of this approach remain unknown. The aims of this study were to assess the long-term effectiveness and safety of endoscopic resection for gastric GISTs. METHODS: A total of 60 consecutive patients undergoing endoscopic resection of gastric GISTs were enrolled in a retrospective single-center study. Clinical data, perioperative complications, histopathologic characteristics of the tumors, and long-term outcomes were recorded...
April 19, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28423997/do-lipid-microemboli-induce-acute-kidney-injury-during-cardiopulmonary-bypass
#15
Richard Issitt, Tim James, Bronagh Walsh, David Voegeli
BACKGROUND: Acute kidney injury (AKI) following cardiopulmonary bypass affects 5% of patients, representing significant postoperative morbidity and mortality. Animal models have shown an increased uptake of lipid microemboli (LME) into the renal vasculature, potentially indicating ischaemic causation. This study tested a new lipid filtration system (RemoweLL) against a conventional system with no lipid-depleting capacity to determine the efficacy of the filtration system and its effects on renal function...
April 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28422908/the-emergency-surgery-score-ess-accurately-predicts-the-occurrence-of-postoperative-complications-in-emergency-surgery-patients
#16
Anirudh R Nandan, Jordan D Bohnen, Naveen F Sangji, Thomas Peponis, Kelsey Han, D Dante Yeh, Jarone Lee, Noelle Saillant, Marc De Moya, George C Velmahos, David C Chang, Haytham M A Kaafarani
BACKGROUND: The Emergency Surgery Score (ESS) was recently validated as a scoring system to predict mortality in emergency surgery (ES) patients. We sought to examine the ability of ESS to predict the occurrence of 30-day postoperative complications in ES. METHODS: The 2011-2012 American College of Surgeons National Surgical Quality.Improvement Program (ACS-NSQIP) database was screened for all surgical operations classified as "emergent". Thirty-day postoperative complications were defined as per ACS-NSQIP (e...
April 18, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28420248/creating-an-optimal-3d-printed-model-for-temporal-bone-dissection-training
#17
Kuniyuki Takahashi, Yuka Morita, Shinsuke Ohshima, Shuji Izumi, Yamato Kubota, Yutaka Yamamoto, Sugata Takahashi, Arata Horii
OBJECTIVE: Making a 3-dimensional (3D) temporal bone model is simple using a plaster powder bed and an inkjet printer. However, it is difficult to reproduce air-containing spaces and precise middle ear structures. The objective of this study was to overcome these problems and create a temporal bone model that would be useful both as a training tool and for preoperative simulation. METHODS: Drainage holes were made to remove excess materials from air-containing spaces, ossicle ligaments were manually changed to bony structures, and small and/or soft tissue structures were colored differently while designing the 3D models...
April 1, 2017: Annals of Otology, Rhinology, and Laryngology
https://www.readbyqxmd.com/read/28420221/a-narrative-review-actigraphy-as-an-objective-assessment-of-perioperative-sleep-and-activity-in-pediatric-patients
#18
REVIEW
Nicole Conrad, Joelle Karlik, Amy Lewandowski Holley, Anna C Wilson, Jeffrey Koh
Sleep is an important component of pediatric health and is crucial for cognitive development. Actigraphy is a validated, objective tool to capture sleep and movement data that is increasingly being used in the perioperative context. The aim of this review is to present recent pediatric studies that utilized actigraphy in the perioperative period, highlight gaps in the literature, and provide recommendations for future research. A literature search was completed using OVID and PubMed databases and articles were selected for inclusion based on relevance to the topic...
April 18, 2017: Children
https://www.readbyqxmd.com/read/28419679/assessing-the-survival-impact-of-perioperative-opioid-consumption-in-children-and-adolescents-undergoing-cytoreductive-surgery-with-hyperthermic-intraperitoneal-chemotherapy
#19
Pascal Owusu-Agyemang, Andrea Hayes-Jordan, Antoinette Van Meter, Uduak U Williams, Acsa M Zavala, Ravish Kapoor, Shannon M Popovich, Elizabeth Rebello, Lei Feng, Juan P Cata
BACKGROUND: Several studies in adult patients have suggested an unfavorable association between opioid consumption and cancer progression. AIMS: This study investigated the impact of opioid consumption on the survival of children and adolescents undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. METHODS: A retrospective study of patients <19 years who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy was performed...
April 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28419229/non-invasive-assessment-of-cerebral-oxygen-metabolism-following-surgery-of-congenital-heart-disease
#20
Felix Neunhoeffer, Katharina Sandner, Milena Wiest, Christoph Haller, Hanna Renk, Matthias Kumpf, Christian Schlensak, Michael Hofbeck
OBJECTIVES: Cerebral protection is a major issue in the treatment of infants with complex congenital heart disease. We tested a new device combining tissue spectrometry and laser Doppler flowmetry for non-invasive determination of cerebral oxygen metabolism following cardiac surgery in infants. METHODS: We prospectively measured regional cerebral oxygen saturation cSO 2 and microperfusion (rcFlow) in 43 infants 12-24 h following corrective ( n  = 30) or palliative surgery ( n  = 13) of congenital heart defects...
April 16, 2017: Interactive Cardiovascular and Thoracic Surgery
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