Timing of cholecystectomy for acute cholecystitis impacts surgical morbidity and mortality: an NSQIP database analysis

In this article, a reproducible process for presenting, analyzing, and reducing early and late surgical morbidity and mortality (M&M) is detailed. All M&M cases presented from 1998 through 2005 at Monmouth Medical Center were categorized. Residents and nurses were empowered to report the complications. The five major categories were overwhelming disease on admission, delays in treatment, diagnostic or judgment complications, treatment complications, and technical complications. From the 53,541 operations performed over 8 years, 714 patients were presented, which included 147 deaths and 1,132 category entries. The most common problems were technical complications in 474 (66.4%) patients. The data have generated actionable solutions, many with low barriers to adoption, resulting in safer, less expensive surgical management. Surgical outcome benchmarks have been established and are used for credentialing surgeons. The “Hostile Abdomen Index” has been developed to assess the safest choice for abdominal operative access, pre- and intraoperatively. We explained the real-time process that generated solutions for the entire department as well as changes relevant to residency training and individual operative techniques.

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An unusual presentation of Gossypiboma associated with secondary infertility: a case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212989 ◽

2021 ◽

Vol 10 (8) ◽

pp. 3236

Author(s):

Eshwarya J. Kaur ◽

Ganesh Saravagi

Keyword(s):

Case Report ◽

Unusual Case ◽

Adnexal Mass ◽

Perioperative Period ◽

Definitive Diagnosis ◽

Unusual Presentation ◽

Morbidity And Mortality ◽

Surgical Morbidity ◽

Secondary Infertility ◽

Abdominal Complications

Gossypibomas are a rare cause of surgical morbidity and mortality. When unrecognised in the perioperative period, they can present later with a myriad of abdominal complications. We present an unusual case of gossypiboma that was discovered as a cause of secondary infertility, misdiagnosed as a complex adnexal mass. After a definitive diagnosis was made, the removal of gossypiboma restored fertility in the patient successfully.

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Lessons Learned From the Surgical Morbidity and Mortality Conference

Journal of Surgical Education ◽

10.1016/j.jsurg.2018.07.002 ◽

2019 ◽

Vol 76 (1) ◽

pp. 174-181 ◽

Cited By ~ 3

Author(s):

Kaio S. Ferreira ◽

Kenneth Lynch ◽

Beth A. Ryder ◽

Michael Connolly ◽

Thomas Miner ◽

...

Keyword(s):

Lessons Learned ◽

Morbidity And Mortality ◽

Surgical Morbidity ◽

Morbidity And Mortality Conference ◽

Mortality Conference

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Emergency subtotal colectomy for fulminant Clostridium difficile colitis – is a surgical solution considered for all patients?

Annals of The Royal College of Surgeons of England ◽

10.1308/003588410x12518836439164 ◽

2010 ◽

Vol 92 (1) ◽

pp. 56-60 ◽

Cited By ~ 24

Author(s):

K Gash ◽

E Brown ◽

A Pullyblank

Keyword(s):

Clostridium Difficile ◽

Subtotal Colectomy ◽

Postoperative Mortality ◽

Antibiotic Use ◽

Morbidity And Mortality ◽

Fulminant Colitis ◽

Surgical Morbidity ◽

Predisposing Factor ◽

Number Of Patients ◽

Neurosurgical Patients

INTRODUCTION Clostridium difficile has been an increasing problem in UK hospitals. At the time of this study, there was a high incidence of C. difficile within our trust and a number of patients developed acute fulminant colitis requiring subtotal colectomy. We review a series of colectomies for C. difficile, examining the associated morbidity and mortality and the factors that predispose to acute fulminant colitis. PATIENTS AND METHODS This is a retrospective study of patients undergoing subtotal colectomy for C. difficile colitis in an NHS trust over 18 months. Case notes were reviewed for antibiotic use, duration of diarrhoea, treatment, blood results, pre-operative imaging and surgical morbidity and mortality. RESULTS A total of 1398 patients tested positive for C. difficile in this period. Of these, 18 (1.29%) underwent colectomy. All were emergency admissions, 35% medical, 35% surgical, 24% neurosurgical and 6% orthopaedic. In the cohort, 29% were aged less than 65 years. Patients had a median of three antibiotics (range, 1–6), for a median of 10 days (range, 0–59 days). Median length of stay prior to C. difficile diagnosis was 13 days. Subtotal colectomy was performed a median of 4 days (range, 0–23 days) after diagnosis. Postoperative mortality was 53% (9 of 17). The median C-reactive protein level for those who died was 302 mg/l, in contrast to 214 mg/l in the survival group. Whilst 62% of all C. difficile cases were medical, the colectomy rate was only 0.7%. In the surgical specialties, the colectomy rates were 3.2% for general surgical, 1.2% for orthopaedic and 8% for neurosurgical patients. CONCLUSIONS Colectomy for C. difficile colitis has a high mortality but can be life-saving, even in extremely sick patients. Although heavy antibiotic use is a predisposing factor, this is not an obligatory prerequisite in the development of C. difficile. Neither is it a disease of the elderly, making it difficult to predict vulnerable patients. There are large differences in colectomy rates between specialties and we suggest there may be a place for a surgical opinion in all cases of severe C. difficile colitis.

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