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Effect of specialization on surgery safety

Jeffrey L Carson, Simon J Stanworth, Nareg Roubinian, Dean A Fergusson, Darrell Triulzi, Carolyn Doree, Paul C Hebert
BACKGROUND: There is considerable uncertainty regarding the optimal haemoglobin threshold for the use of red blood cell (RBC) transfusions in anaemic patients. Blood is a scarce resource, and in some countries, transfusions are less safe than others because of a lack of testing for viral pathogens. Therefore, reducing the number and volume of transfusions would benefit patients. OBJECTIVES: The aim of this review was to compare 30-day mortality and other clinical outcomes in participants randomized to restrictive versus liberal red blood cell (RBC) transfusion thresholds (triggers) for all conditions...
October 12, 2016: Cochrane Database of Systematic Reviews
Stefan Linsler, Sebastian Antes, Sebastian Senger, Joachim Oertel
OBJECTIVE: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. MATERIALS AND METHODS: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated...
October 2016: Journal of Neurosciences in Rural Practice
Peyman Sardari Nia, Samuel Heuts, Jean Daemen, Peter Luyten, Jindrich Vainer, Jan Hoorntje, Emile Cheriex, Jos Maessen
OBJECTIVES: Mitral valve repair performed by an experienced surgeon is superior to mitral valve replacement for degenerative mitral valve disease; however, many surgeons are still deterred from adapting this procedure because of a steep learning curve. Simulation-based training and planning could improve the surgical performance and reduce the learning curve. The aim of this study was to develop a patient-specific simulation for mitral valve repair and provide a proof of concept of personalized medicine in a patient prospectively planned for mitral valve surgery...
September 27, 2016: Interactive Cardiovascular and Thoracic Surgery
Johannes Oppermann, Jan Bredow, Christian K Spies, Julia Lemken, Frank Unglaub, Christoph K Boese, Jens Dargel, Peer Eysel, Jan Zöllner
PURPOSE: The purpose of this study was to examine the effect of postoperative prolonged release oxycodone/naloxone (OXN) in comparison to other opioids (control group) on the early postoperative rehabilitation outcome after total knee replacement. METHODS: In a prospective, noninterventional, nonrandomized clinical trial, 80 patients were assigned to either the OXN group or a control group. Postoperative outcome and pain level at days 3, 6, 21, 35, and 6months were evaluated using the Bowel Function Index, Brief Pain Inventory Short Form questionnaire, the Hospital for Special Surgery score, modified Larson score, and the ability to attend physiotherapy...
September 2016: Journal of Clinical Anesthesia
S Tola, M De Angelis, S Bistazzoni, C Chiaramonte, V Esposito, S Paolini
OBJECTIVE: To demonstrate the effectiveness and safety of hemilaminectomy in spinal-meningioma surgery, with special attention to ventral lesions. We also describe technical tips to enhance surgical-corridor width. PATIENTS AND METHODS: A total of 20 patients (14 female and 6 male) underwent hemilaminectomy for resection of a spinal meningioma between January 2005 and December 2015. Preoperative magnetic resonance imaging defined the tumor location (16 thoracic, 3 cervical, 1 lumbar) and the dural-attachment site (4 ventral, 11 ventrolateral, 3 lateral, 2 posterior)...
September 2016: Clinical Neurology and Neurosurgery
Safiya I Shaikh, Sarala B Mahesh
BACKGROUND AND AIMS: Alpha (α-2) adrenergic agonists have both analgesic and sedative properties when used as an adjuvant in regional anesthesia. A prospective randomized double-blind study was carried out to evaluate the efficacy of epidural route and to compare the efficacy and clinical profile of dexmedetomidine and clonidine as an adjuvant to bupivacaine with special emphasis on their quality of analgesia, sedation and the ability to provide the smooth intra-operative and postoperative course...
April 2016: Journal of Anaesthesiology, Clinical Pharmacology
Jin-Young Jang, Jin Seok Heo, Youngmin Han, Jihoon Chang, Jae Ri Kim, Hongbeom Kim, Wooil Kwon, Sun-Whe Kim, Seong Ho Choi, Dong Wook Choi, Kyoungbun Lee, Kee-Taek Jang, Sung-Sik Han, Sang-Jae Park
Laparoscopic surgery has been widely accepted as a feasible and safe treatment modality in many cancers of the gastrointestinal tract. However, most guidelines on gallbladder cancer (GBC) regard laparoscopic surgery as a contraindication, even for early GBC. This study aims to evaluate and compare recent surgical outcomes of laparoscopic and open surgery for T1(a,b) GBC and to determine the optimal surgical strategy for T1 GBC.The study enrolled 197 patients with histopathologically proven T1 GBC and no history of other cancers who underwent surgery from 2000 to 2014 at 3 major tertiary referral hospitals with specialized biliary-pancreas pathologists and optimal pathologic handling protocols...
May 2016: Medicine (Baltimore)
Jaishankar Raman, Nancy Leveson, Aubrey Lynn Samost, Nikola Dobrilovic, Maggie Oldham, Sidney Dekker, Stan Finkelstein
OBJECTIVES: Checklists are being introduced to enhance patient safety, but the results have been mixed. The goal of this research is to understand why time-outs and checklists are sometimes not effective in preventing surgical adverse events and to identify additional measures needed to reduce these events. METHODS: A total of 380 consecutive patients underwent complex cardiac surgery over a 24-month period between November 2011 and November 2013 at an academic medical center, out of a total of 529 cardiac cases...
August 2016: Journal of Thoracic and Cardiovascular Surgery
Andrea Imperatori, Annamaria Grande, Massimo Castiglioni, Laura Gasperini, Agnese Faini, Sebastiano Spampatti, Elisa Nardecchia, Lorena Terzaghi, Lorenzo Dominioni, Nicola Rotolo
OBJECTIVES: Kinesiology taping (KT) is a rehabilitative technique performed by the cutaneous application of a special elastic tape. We tested the safety and efficacy of KT in reducing postoperative chest pain after lung lobectomy. METHODS: One-hundred and seventeen consecutive patients, both genders, age 18-85, undergoing lobectomy for lung cancer between January 2013 and July 2015 were initially considered. Lobectomies were performed by the same surgical team, with thoracotomy or video-assisted thoracoscopic surgery (VATS) access...
August 2016: Interactive Cardiovascular and Thoracic Surgery
Amir H Kashani
Age-related macular degeneration (ARMD) is the leading cause of blindness in subjects older than 50 years of age in the developed world. There are two types of ARMD, neovascular (NV) and nonneovascular (NN). While anti-VEGF-based therapies have significantly decreased the visual morbidity associated with NV-ARMD, there are no effective treatments for NN-ARMD. A detailed discussion of NV-ARMD and related therapies is the topic of another section of this special supplement. This review will focus mainly on NN-ARMD...
April 1, 2016: Investigative Ophthalmology & Visual Science
Yifei Lin, Sike Lai, Jin Huang, Liang Du
The knotless barbed suture is an innovative type of suture that can accelerate the placement of sutures and eliminate knot tying. However, the outcomes of previous studies are still confounding. This study reviewed the application of different types of barbed sutures in different surgeries. We searched PubMed, EMBASE, CENTRAL and to identify randomized controlled trials (RCTs) addressing the application of barbed sutures up to Feb. 2015. Two reviewers independently screened the literature and assessed the risk of bias of included studies...
2016: Scientific Reports
Jonathan Botting, Ana Correa, James Duffy, Simon Jones, Simon de Lusignan
BACKGROUND: Minor surgery is a well-established part of family practice, but its safety and cost-effectiveness have been called into question. AIM: To audit the performance of GP minor surgeons in three different settings. DESIGN AND SETTING: A community-based surgery audit of GP minor surgery cases and outcomes from three settings: GPs who carried out minor surgery in their practice funded as enhanced (primary care) services (ESGPs); GPs with a special interest (GPwSIs) who worked independently within a healthcare organisation; and GPs working under acute trust governance (Model 2 GPs)...
May 2016: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Chong-Zhi Wang, Jonathan Moss, Chun-Su Yuan
BACKGROUND: Patients who undergo surgery appear to use dietary supplements significantly more frequently than the general population. Because they contain pharmacologically active compounds, dietary supplements may affect coagulation and platelet function during the perioperative period through direct effects, pharmacodynamic interactions, and pharmacokinetic interactions. However, in this regard, limited studies have been conducted that address the pharmacological interactions of dietary supplements...
September 2015: Medicines (Basel, Switzerland)
Zhen-zhou Li, Shu-xun Hou, Wei-lin Shang, Zheng Cao, Hong-liang Zhao
OBJECTIVE: To evaluate the outcome and safety of percutaneous lumbar foraminoplasty (PLF) and percutaneous endoscopic lumbar decompression (PELD) with specially designed instrument for lumbar lateral recess stenosis with/without herniated discs (HDs). METHOD: From August of 2011 to August of 2013, 96 patients met the inclusion criteria were treated with PLF-PELD and 85 cases were followed up to 2 years postoperatively. MRI or CT checkup performed in the next morning after operation...
April 2016: Clinical Neurology and Neurosurgery
Shu-Hung Chuang, Chih-Sheng Lin
Single-incision laparoscopic surgery (SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy (SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials (RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain...
January 14, 2016: World Journal of Gastroenterology: WJG
Maria C Mir, Nicola Pavan, Dipen J Parekh
PURPOSE: Partial nephrectomy is the accepted standard of care for treatment of patients with small renal masses. The primary goal while performing partial nephrectomy is cancer control with a secondary important goal of maximizing renal function preservation with minimal perioperative morbidity. Recent studies have highlighted the importance of renal parenchymal quality and quantity postoperatively rather than duration of ischemia in determining long-term renal function. We review the available data regarding perioperative renal function optimization with special interest in ischemia during partial nephrectomy, highlighting the controversies and establishing future lines of investigation...
June 2016: Journal of Urology
Katarina Göransson, Johan Lundberg, Olle Ljungqvist, Elisabet Ohlsson, Gabriel Sandblom
BACKGROUND: Many adverse events occur due to poor communication between surgical and anesthesia unit personnel. The aim of this study was to identify strategies to reduce risks unveiled by a national survey on patient safety. METHODS: During 2011-2015, specially trained survey teams visited the surgery departments at Swedish hospitals and documented routines concerning safety in abdominal surgery. The reports from the first seventeen visits were reviewed by an independent group in order to extract findings related to routines in communication between anesthesia and surgical unit personnel...
2016: Patient Safety in Surgery
Selim Ayhan, Bilal Aykac, Selcen Yuksel, Umit Ozgur Guler, Ferran Pellise, Ahmet Alanay, Francisco Javier Sanchez Perez-Grueso, Emre Acaroglu
PURPOSE: Spinal surgery for adult spinal deformity (ASD) may require the use of osteotomies, which may have high complication rates (up to 80 %). These may be expected to affect health-related quality of life (HRQOL) in the early postoperative phase but little is known about the clinical course of these patients in the first year following surgery. The aim of the study is to evaluate the radiological results and HRQOL in patients undergoing a spinal osteotomy for ASD within the first year following surgery with special reference to the effect of complications...
August 2016: European Spine Journal
Umberto Leone Roberti Maggiore, Giorgio Bogani, Michele Meschia, Paola Sorice, Andrea Braga, Stefano Salvatore, Fabio Ghezzi, Maurizio Serati
Bulking agents provide an alternative option in the management of women with stress urinary incontinence and they seem to have an important role in the management flow chart of SUI. However, evidence on this issue is scanty. The most important aspect is to understand whether bulking agents are comparable with the other first-line anti-incontinence surgical procedure (MUS, Burch colposuspension and pubovaginal slings). Hence, the primary aim of the current review was to assess the objective and subjective outcomes of bulking agents in comparison with the other surgical procedures for the treatment of SUI...
June 2015: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Qi Chen, Xiaofeng Xu, Yonghui Huang, Xingbing Cao, Chen Meng, Xueshu Cao, Changbao Wei
OBJECTIVE: To introduce the surgery method to reset and fix tibial plateau fracture without opening joint capsule, and evaluate the safety and effectiveness of this method. METHODS: Between July 2011 and July 2013, 51 patients with tibial plateau fracture accorded with the inclusion criteria were included. All of 51 patients, 17 cases underwent open reduction and internal fixation without opening joint capsule in trial group, and 34 cases underwent traditional surgery method in control group...
December 2014: Chinese Journal of Reparative and Reconstructive Surgery
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