Summary
The association between intra‐operative hypotension and postoperative acute kidney injury, mortality and length of stay has not been comprehensively evaluated in a large single‐centre hip ...fracture population. We analysed electronic anaesthesia records of 1063 patients undergoing unilateral hip fracture surgery, collected from 2015 to 2018. Acute kidney injury, 3‐, 30‐ and 365‐day mortality and length of stay were evaluated to assess the relationship between intra‐operative hypotension absolute values (≤ 55, 60, 65, 70 and 75 mmHg) and duration of hypotension. The rate of acute kidney injury was 23.7%, mortality at 3‐, 30‐ and 365 days was 3.7%, 8.0% and 25.3%, respectively, and median (IQR range) length of stay 8 (6–12 0–99) days. Median (IQR range) time ≤ MAP 55, 60, 65, 70 and 75 mmHg was 0 (0–0.50–72.1); 0 (0–4.4 0–104.9); 2.2 (0–8.7 0–144.2); 6.6 (2.2–19.7 0–198.8); 17.5 (6.6–37.1 0–216.3) minutes, and percentage of surgery time below these thresholds was 1%, 2.5%, 7.9%, 12% and 21% respectively. There were some univariate associations between hypotension and mortality; however, these were no longer evident in multivariable analysis. Multivariable analysis found no association between hypotension and acute kidney injury. Acute kidney injury was associated with male sex, antihypertensive medications and cardiac/renal comorbidities. Three‐day mortality was associated with delay to surgery ? 48 hours, whilst 30‐day and 365‐day mortality was associated with delay to surgery ≥ 48 hours, impaired cognition and cardiac/renal comorbidities. While the rate of acute kidney injury was similar to other studies, use of vasopressors and fluids to reduce the time spent at hypotensive levels failed to reduce this complication. Intra‐operative hypotension at the levels observed in this cohort may not be an important determinant of acute kidney injury, postoperative mortality and length of stay.
Pressure ulcer (PU), also called pressure injury, is localized damage to the skin and underlying soft tissues, usually over bony prominences, as a result of sustained mechanical loads applied to the ...tissues. However, in many situations, complete off-loading of sacral PUs is not possible. Minimising the exposure of wounds and their surroundings to elevated mechanical loads is crucial for healing. We for the first time reported the application of Meipicang in the prevention and treatment of intraoperative pressure ulcers in elderly ICU patients with severe illness. We found that the pressure ulcer risk score (20.15±2.17) in the dressing group after intervention was higher than that (17.42±3.62) in the regular group. The incidence of pressure sores in the dressing group was 3.77% lower than the 18.88% in the regular group. The psychological concern score (31.41±3.15) of the dressing group was higher than that (26.92±3.43) of the regular group. The trust score (29.57±2.61) of the dressing group was higher than the score (24.28±2.29) of the regular group. The score of physiological problems in the dressing group (34.69±3.82) is higher than that in the regular group (29.88±3.54). The skin complication rate of the dressing group was 5.56% lower than that of the regular group (22.64%). The comfort score (92.46 ± 4.15) of the dressing group was higher than that (80.59±5.43) of the regular group. The nursing satisfaction score (94.53±3.72) of the dressing group was higher than that (81.79±4.61) of the regular group. To conclude, in this study, we found that the Meipicang dressing can reduce the incidence of pressure ulcers in ICU patients with severe ICU and improve the comfort and nursing satisfaction of elderly ICU patients with severe ICU, which is worthy of promotion.
The objective of this study is to examine the relationship between body mass index (BMI) and complications for patients undergoing postpartum permanent contraception.
Retrospective cohort study of ...patients aged 18 or older who had a vaginal delivery at an academic hospital between 2011 and 2016 and underwent a postpartum tubal ligation during the delivery admission. There were three comparative groups: nonobese (BMI ≤ 29 kg/m
), obese (BMI 30-39 kg/m
), and morbidly obese BMI (≥40 kg/m
). The outcome of interest was composite operative complications which included any occurrence of an intraoperative, postoperative, or anesthesia complication.
A total of 921 patients were included for analysis. Average operative time was statistically longer for patients in the morbidly obese group (33 minutes) vs. the nonobese (25 minutes) and obese (29 minutes) groups (
0.0001). Composite complications were greater for the obese groups, but not statistically significant (5.1 vs. 6 vs. 16%,
= 0.06). Wound complications were significantly greater for the obese groups (0.8 vs. 1.5 vs. 5.5%,
= 0.01). A logistic regression model demonstrated that only operative time was predictive of operative complications.
Overall complications of postpartum tubal complications are low; however, our study did demonstrate significantly longer operative time and wound complications for patients with obesity. The findings of our study indicate that postpartum permanent contraception can remain as an option for these patients. Further studies may help identify the best practices to decrease operative time and subsequent wound complications. This study contributes to the limited data regarding obesity and postpartum permanent contraception. We found increased operative time and wound complications for obese patients. Additional studies may identity best practices to decrease these complications. Given our findings of overall low operative complications, postpartum permanent contraception can remain an option for obese patients.
Third universal definition of myocardial infarction THYGESEN, Kristian; ALPERT, Joseph S; JAFFE, Allan S ...
European heart journal,
10/2012, Letnik:
33, Številka:
20
Journal Article, Conference Proceeding, Web Resource
Simulation-Based Trial of Surgical-Crisis Checklists Arriaga, Alexander F; Bader, Angela M; Wong, Judith M ...
New England journal of medicine/The New England journal of medicine,
01/2013, Letnik:
368, Številka:
3
Journal Article
Recenzirano
Odprti dostop
In this study, the authors designed checklists to guide care during operating-room crises and evaluated them in a simulated operating room. The availability of checklists improved adherence to best ...practices by operating-room teams during simulations of surgical crises.
Operating-room crises (e.g., massive hemorrhage and cardiac arrest) are high-risk, stressful events that require rapid and coordinated care in a time-critical setting. The reported incidence may be rare for an individual practitioner,
1
but the aggregate incidence for a hospital with 10,000 operations a year is estimated to be approximately 145 such events annually.
2
These are situations in which the way the team cares for a patient will make the difference between life and death. Failure to effectively manage life-threatening complications in surgical patients has been recognized as the largest source of variation in surgical mortality among hospitals.
3
–
7
Small-scale studies . . .
Background
This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative ...protocol.
Methods
Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group.
Results
For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (quality of evidence and recommendations according to the GRADE system).
Conclusions
Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolism (ESPEN) present a comprehensive evidence-based consensus review of perioperative care for colonic surgery.
Intraoperative consultations are an important component of acute care surgery (ACS). The nature of these consultations is incompletely characterized by the existing literature. The study objective ...was to define the characteristics of intraoperative consults managed by a mature ACS program at a Level I trauma center. All intraoperative consultations requested from the ACS service at LAC1USC Medical Center (January 2011–July 2016) were identified. Demographics, date/time of consultation, referring service, procedure data, and outcomes were abstracted. Sixty-four intra-operative consultations were identified. Patients had a mean age of 45 (range 21–64) and 84 per cent (n = 54) were female. Gynecology was the most frequent consulting service (n = 42, 66%), followed by urology (n = 12, 19%). Surgical intervention was required in 61 per cent (n = 39) and verbal advice with clinical follow-up was required in 39 per cent (n = 25). The most common procedures were repair of an injury (n = 19, 49%), usually to the small bowel or colon; resection of an incidental finding (n = 13, 33%), typically the appendix or a Meckel's diverticulum; and lysis of adhesions (n = 7, 18%). In conclusion, intraoperative consultation is provided by ACS to a wide range of consultants, especially gynecology and urology. These consults are most frequently requested for concern for iatrogenic injury. Both surgical and verbal interventions are used.
Hyperglycemia in perioperative patients has been identified as a risk factor for morbidity and mortality. Intensive insulin therapy (IIT) has been shown to reduce morbidity and mortality among the ...critically ill, decrease infection rates and improve survival after cardiac surgery, and improve outcomes in acute neurologic injury and acute myocardial infarction. However, recent evidence of severe hypoglycemia and adverse events associated with IIT brings its safety and efficacy into question. In this article, we summarize the mechanisms and rationale of hyperglycemia and IIT, review the evidence behind the use of IIT in the perioperative period, and discuss the implications of including glycemic control in national quality benchmarks. We conclude that while avoidance of hyperglycemia is clearly beneficial, the appropriate glucose target and specific subpopulations who might benefit from IIT have yet to be identified. Given the potential for harm, inclusion of glucose targets in national quality benchmarks is premature.
To report the vitreoretinal (VR) surgical case mix in the United Kingdom, the intraoperative complication rate of pars plana vitrectomy (PPV), and the incidence of post-vitrectomy cataract ...extraction.
Participating hospitals prospectively collected ophthalmic data using a single electronic medical record system, with automatic extraction of anonymised data to a national database. This study included the subset of 11618 VR operations undertaken on 9619 eyes, of 8741 patients, over 8 years, from 27 sites. Surgical data included the indication for surgery, all procedure elements, and whether or not an intraoperative complication occurred. Post-vitrectomy cataract data were also analysed. The main outcome measures were a description of the indications for surgery, intraoperative PPV complication rate, and percentage of eyes undergoing post-vitrectomy cataract surgery (PVCS).
The most common indications for VR intervention were retinal breaks and rhegmatogenous retinal detachment (48.5%), macular hole (9.8%), epiretinal membrane (9.6%), and diabetic eye disease (7.3%). Overall, 7.8% of PPVs had at least one intraoperative complication-the most common were iatrogenic retinal breaks (3.2%), and lens touch (1.2-1.6% of phakic eyes). PVCS occurred in 50.2, 68.7, and 74.0% of eyes at 1, 2, and 3 years, respectively.
VR surgery is undertaken for a wide range of conditions, but a small number of diagnoses encompass the majority of cases. Intraoperative PPV complications are not uncommon, and post-vitrectomy cataract is to be expected in most phakic eyes.
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