scholarly journals Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits

2020 ◽  
Author(s):  
Cecilia Botti ◽  
Francesca Lusetti ◽  
Tommaso Neri ◽  
Stefano Peroni ◽  
Andrea Castellucci ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Complication Rates ◽  
Risks And Benefits ◽  
Relative Risks ◽  
Percutaneous Dilatational Tracheotomy

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

2021 ◽  
pp. 1-8
Author(s):  
Przemysław Adamczyk ◽  
Paweł Pobłocki ◽  
Mateusz Kadlubowski ◽  
Adam Ostrowski ◽  
Witold Mikołajczak ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Complication Rate ◽  
Tnm Stage ◽  
Complication Rates ◽  
Open Approach ◽  
Invasive Approach ◽  
Asa Score

<b><i>Purpose:</i></b> This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. <b><i>Methods:</i></b> A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). <b><i>Results:</i></b> The surgical technique was significantly related to the number of complications (<i>p</i> &#x3c; 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (<i>p</i> &#x3c; 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (<i>p</i> &#x3c; 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. <b><i>Conclusions:</i></b> The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

A Novel Surgical Technique for Large Frontoencephalocele Management: The Mercy Ships Approach

FACE ◽  
2021 ◽  
pp. 273250162097932
Author(s):  
Naikhoba C. O. Munabi ◽  
Eric S. Nagengast ◽  
Gary Parker ◽  
Shaillendra A. Magdum ◽  
Mirjam Hamer ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Intraoperative Complications ◽  
Complication Rates ◽  
The Novel ◽  
Middle Income ◽  
Middle Income Countries ◽  
Lumbar Drain ◽  
Cerebral Herniation ◽  
Long Nose

Background: Large frontoencephaloceles, more common in low and middle-income countries, require complex reconstruction of cerebral herniation, elongated nose, telecanthus, and cephalic frontal bone rotation. Previously described techniques involve multiple osteotomies, often fail to address cephalad brow rotation, and have high complication rates including up to 35% mortality. This study presents a novel, modified, single-staged technique for frontoencephalocele reconstruction performed by Mercy Ships. This technique, which addresses functional and aesthetic concerns with minimal osteotomies, may help improve outcomes in low resources settings. Methods: Retrospective review was performed of patients who underwent frontoencephalocele reconstruction through Mercy Ships using the technique described. Patient data including country, age, gender, associated diagnoses, and prior interventions were reviewed. Intraoperative and post-operative complications were recorded. Results: Eight patients with frontoencephalocele (ages 4-14 years) underwent surgery with the novel technique in 4 countries. Average surgical time was 6.0 ± 0.9 hours. No intraoperative complications occurred. Post-operatively 1 patient experienced lumbar drain dislodgement requiring replacement and a second had early post-operative fall requiring reoperation for hardware replacement. In person follow-up to 2.4 months showed no additional complications. Follow-up via phone at 1 to 2 years post-op revealed all patients who be satisfied with surgical outcomes. Conclusions: Reconstruction of large frontoencephaloceles can be challenging due to the need for functional closure of the defect and craniofacial reconstruction to correct medial hypertelorism, long nose deformity, and cephalad forehead rotation. The novel surgical technique presented in this paper allows for reliable reconstruction of functional and aesthetic needs with simplified incision design, osteotomies, and bandeau manipulation.

The capacity to designate a surrogate is distinct from decisional capacity: normative and empirical considerations

2021 ◽  
pp. medethics-2020-107078
Author(s):  
Mark Navin ◽  
Jason Adam Wasserman ◽  
Devan Stahl ◽  
Tom Tomlinson
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decisional Capacity ◽  
Risks And Benefits ◽  
Relative Risks ◽  
Decision Making Capacity ◽  
Cognitive Diseases ◽  
Surrogate Selection

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer’s disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions.

A Quality Assessment of Online Patient Information Regarding Rhinoplasty

2021 ◽  
Author(s):  
Eamon Shamil ◽  
Gabriela Di Scenza ◽  
Shahi Abdul Ghani ◽  
Ka Siu Fan ◽  
Suthaharan Ragulan ◽  
...  
Keyword(s):  
Patient Information ◽  
Poor Quality ◽  
Complication Rates ◽  
Eligibility Criteria ◽  
Risks And Benefits ◽  
Search Terms ◽  
Outcome Management ◽  
Balanced Information ◽  
Unrealistic Expectations

AbstractThere is a large demand for online patient information for patients considering rhinoplasty. While there are many resources available, the quality and content of the information provided are unknown. This study aimed to assess the quality of the most popular information available online, using the “Ensuring Quality Information for Patients” (EQIP) tool to evaluate the content, structure, and readability of patient information on websites. Search terms including nose operation, nose job, nose reshaping, nose tip surgery, rhinoplasty, septorhinoplasty, were identified using Google AdWords and Trends. Unique links from the first 10 pages for each term were identified and evaluated with websites written in English and for general non-medical public use were included. 295 websites met the eligibility criteria with a median overall EQIP score of 17. Only 33% contained balanced information on the risks and benefits. Bleeding and infection risk was only mentioned in 29% and 27% of websites, respectively. Two percent described complication rates of the procedures and only 20% of articles explained further surgery may be required to achieve patient cosmetic or functional satisfaction. Information regarding rhinoplasty available online is currently of poor quality. The lack of effective risk counselling, possible outcome management, and complications may likely lead to unrealistic expectations of rhinoplasty. It is crucial the risks of surgery are communicated to the patient to ensure they can make an informed decision. Improved education through online resources would likely help to promote more realistic patient expectations.

scholarly journals Use of Research Biopsies in Clinical Trials: Are Risks and Benefits Adequately Discussed?

2013 ◽  
Vol 31 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Michael J. Overman ◽  
Janhavi Modak ◽  
Scott Kopetz ◽  
Ravi Murthy ◽  
James C. Yao ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Tumor Tissue ◽  
Eligibility Criterion ◽  
Solid Organ ◽  
Complication Rates ◽  
Limited Information ◽  
Risks And Benefits ◽  
Study Protocols ◽  
Primary Indication ◽  
Biomarker Analysis

Purpose Although the incorporation of research biopsies into clinical trials is increasing, limited information is available about how study protocols and informed consents integrate and describe their use. Methods All therapeutic clinical trials in which image-guided research biopsies were performed from January 1, 2005, to October 1, 2010, were identified from an interventional radiology database. Data from study protocols and informed consents were extracted and analyzed. Procedural complications were recorded. Results A total of 57 clinical trials were identified, of which 38 (67%) contained at least one mandatory biopsy. The analysis of the research biopsy tumor tissue was a study end point in 95% of trials. The primary indication for a research biopsy was for integral biomarker analysis in 32% and for correlative science in 68% of trials. A statistical analytic plan for the correlative science research biopsy tumor tissue was mentioned in 26%, described as exploratory in 51%, and not mentioned in 23% of trials. For studies with mandatory biopsies, biopsy was an eligibility criterion in 71% of trials, and a statistical justification for the research biopsy sample size was present in 50% of trials. A total of 745 research biopsies were performed on 576 patients. Overall and major complication rates were 5.2% (39 of 745 biopsies) and 0.8% (six of 745 biopsies), respectively. Complication rates for intrathoracic and abdominal/pelvic solid organ biopsies were 17.1% (36 of 211 biopsies) and 1.6% (three of 189 biopsies), respectively. Site-stratified research biopsy–related risks were discussed in five consents. Conclusion A better representation of the risks and benefits of research biopsies in study protocols and informed consents is needed.

Surgery for Pediatric Ureteropelvic Junction Obstruction—Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany

2018 ◽  
Vol 29 (01) ◽  
pp. 033-038 ◽  
Author(s):  
M. Klora ◽  
J. Zeidler ◽  
S. Eberhard ◽  
S. Bassler ◽  
S. Mayer ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Ureteropelvic Junction Obstruction ◽  
Length Of Hospital Stay ◽  
Ureteropelvic Junction ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Laparoscopic Pyeloplasty ◽  
Small Children ◽  
The Mean ◽  
Open Pyeloplasty

Introduction Surgery for ureteropelvic junction obstruction (UPJO) is performed by both pediatric surgeons (PS) and urologists (URO). The aim of this study was to analyze treatment modalities for UPJO and results in relation to the surgical technique and the operating discipline in Germany. Materials and Methods Data of patients aged 0 to 18 years were extracted from a major public health insurance (covering ∼5.7 million clients) during 2009 to 2016 and were analyzed for sociodemographic variables, surgical technique, and treating discipline. Logistic regression analysis was performed for the risk of a complication within the first postoperative year. Results A total of 229 children (31.0% female) were included. Laparoscopic pyeloplasty (LP) was performed in 58 (25.3%) patients (8.6 ± 6.4 years), and open pyeloplasty (OP) was applied in 171 (74.7%; 4.6 ± 5.9 years). LP was the dominant technique in females (p < 0.02); males preferentially underwent OP (p < 0.02). Length of hospital stay was 4.3 days (p = 0.0005) shorter in LP compared with that in OP, especially in children ≤ 2 years (6.7 days, p = 0.007). PS operated on 162 children (70.7%), and URO performed surgery on 67 patients (29.3%). The mean age of children operated by PS (3.5 ± 4.7 years) was significantly younger compared with that operated by URO (10.8 ± 6.5 years, p < 0.0001). Complication rates were independent of surgical technique or treating specialty. Conclusion In Germany, UPJO was treated by LP in 25.3% of patients, which was associated with a shorter length of stay, especially in children ≤ 2 years. Complication rates were independent of the operating specialty and surgical technique. Therefore, LP should be further promoted for the treatment of UPJO in small children.

Widespread Subcutaneous Emphysema After J-Plasma Therapy

2020 ◽  
pp. 074880682094790
Author(s):  
Jia Y. Lim ◽  
Muhammad Umair Javed ◽  
Wiktor Pilch ◽  
Abdullah Ibrahim ◽  
Jack Harbison
Keyword(s):  
Surgical Technique ◽  
Plastic Surgery ◽  
Subcutaneous Emphysema ◽  
Subcutaneous Tissue ◽  
Rare Complication ◽  
Plasma Therapy ◽  
Postoperative Assessment ◽  
Risks And Benefits ◽  
Surgery Department ◽  
Fatal Complications

Subcutaneous emphysema refers to the abnormal presence of free gas within the subcutaneous tissue. Its cause can be broadly classified into 3 main causes: (1) infection by gas-forming microorganisms, (2) visceral perforation of luminal organs, and (3) spontaneous alveolar rupture. We report a case of a 48-year-old lady who developed extensive subcutaneous emphysema after undergoing VASER-assisted liposuction and J-Plasma® therapy at a local cosmetic clinic. The patient was admitted to our tertiary plastic surgery department where she was managed conservatively and discharged at day 3 without any complications. Subcutaneous emphysema is a known but rare complication of liposuction. While subcutaneous emphysema is usually self-limiting, fatal complications can occur. As such, patients considering these procedures should be informed of its risks and benefits to allow them to make an informed decision. This report highlights the importance of meticulous surgical technique in liposuction and its postoperative assessment.

Arthroscopic iliopsoas tenotomies: a systematic review of surgical technique and outcomes

2020 ◽  
pp. 112070002097051
Author(s):  
Remy Coulomb ◽  
Bastien Nougarede ◽  
Etienne Maury ◽  
Philippe Marchand ◽  
Olivier Mares ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Technique ◽  
Complication Rate ◽  
Data Extraction ◽  
Central Compartment ◽  
Direct Access ◽  
Cochrane Library ◽  
Complication Rates ◽  
Lesser Trochanter ◽  
Loss Of Strength

Purpose: To evaluate the technique, results and complications of arthroscopic iliopsoas tenotomies either on native hips or total hip arthroplasty (THA). Methods: A systematic review was performed using 3 databases: PubMed, EMBASE and the Cochrane library from January 2000 to December 2018 in accordance with the PRISMA procedure. The literature search, data extraction and quality assessment were conducted by 2 independent reviewers. Surgical technique, clinical outcomes, recurrences and complication rate were evaluated. Results: Out of 115 articles reviewed, 20 articles concerned native hips and 8 articles THA. 3 levels of release were described. For native hips, the recurrence rate was higher for central compartment than peripheral or lesser trochanter releases. Complication rates were similar for hip arthroscopy but remained low in all series. Loss of strength was evaluated mainly using the MRC muscle scale. Most studies noted strength recovery. MRI analysis of muscle atrophy was greater for lesser trochanter than for central compartment release but unrelated to loss of strength. The complication rate was low for tenotomy after THA, heterotopic ossification being the most common complication. Conclusions: Central compartment releases lead to the highest rate of recurrence due to incomplete release. Peripheral releases have a potential risk of vascular injury. The lesser trochanteric approach has the disadvantage of not having direct access to the joint. The main difficulty with THA lies in the diagnosis of cup/iliopsoas impingement. Diagnostic tests with infiltration should be made before iliopsoas release to prevent its failure. Cup protrusion of over 8mm is a potential indication for acetabular revision.

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