scholarly journals 709 A Prospective Analysis of Post-Tonsillectomy Haemorrhage and Hospital Reamission Rates in A Tertiary Pediatric Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Thompson ◽  
I Street
Keyword(s):  
Perioperative Management ◽  
Surgical Intervention ◽  
National Average ◽  
Complication Rates ◽  
National Data ◽  
Readmission Rates ◽  
Phone Survey ◽  
Care Costs ◽  
Inclusion Period ◽  
Haemorrhage Rate

Abstract Introduction Tonsillectomies are one of the most commonly performed procedures., with one particular leading tertiary paediatric centre performing 1,067 tonsillectomies within the last year. Post-tonsillectomy haemorrhage is a considerable complication leading to further primary care costs, readmission, and surgical intervention. Previous national audits have suggested that post-tonsillectomy haemorrhage rates are between 3.0-3.5%1 and readmission rates are approximately 8.8%2. Aim Assess post-tonsillectomy haemorrhage and readmission rates at a leading tertiary paediatric centre. Method A prospective phone survey was completed for every patient receiving a tonsillectomy 6 weeks post-operatively, using a 2-month inclusion period. Results Of the 51 patients included, 51 responded to phone survey. The total post-tonsillectomy haemorrhage rate was 23.5%. Of the 51 respondents, 10 (19.6%) were readmitted through A&E, all of which had extracapsular tonsillectomies. 1 (10%) of those readmitted had further surgical intervention whilst the remaining 9 (90%) were treated conservatively. A further 4 (7.8%) attended their GP, with 3 (75%) of those requiring antibiotics. Conclusions This data shows that both the post-tonsillectomy haemorrhage and readmission rates at the tertiary paediatric centre were higher than the national average. We suggest that previous national data audits describing bleeding rates lack the granularity to reveal true post-operative complication rates. Our prospective cohort has demonstrated that there may be a large proportion of patients with morbidity that never reach the attention of the ENT surgeon and additionally that subgroups in particular may benefit from interventions designed to minimise patients’ post-operative risks, including specific perioperative management and advice.

scholarly journals A Review of the Pathogenesis of Osteoarthritis and the Use of Intra-articular Platelet Therapy for Joint Disease in Animals and Humans

2014 ◽  
Vol 5 ◽  
pp. BTRI.S14578 ◽  
Author(s):  
Girolamo A. Ortolano ◽  
Barry Wenz
Keyword(s):  
Health Care ◽  
Stem Cells ◽  
Surgical Intervention ◽  
Domestic Animals ◽  
Medical Intervention ◽  
Joint Disease ◽  
Therapeutic Approaches ◽  
Disease Modifying ◽  
Care Costs ◽  
Clinical Problems

Osteoarthritis (OA) is the most prevalent musculoskeletal disease in humans and domestic animals. It causes significant clinical problems and substantial health care costs. In the absence of disease-modifying medical intervention, therapy is currently restricted to palliative measures prior to surgical intervention. We review the pathogenesis, as well as conservative and emerging restorative therapeutic approaches, including cytokines, stem cells, and platelets. The various methods of platelet concentrate preparations and their reported outcomes are discussed. Data collected from the use of intra-articular platelet therapy (IAPT) in dogs are reviewed, which suggest that this approach may delay or in some cases even obviate the need for surgical intervention.

scholarly journals Focus on the totally laparoscopic feeding gastrostomy tube placement operative technique

2021 ◽  
Vol 9 (1) ◽  
pp. 127-133
Author(s):  
Sorin Cimpean ◽  
Alexandre Grapotte ◽  
Nicolas Boyer ◽  
Mathilde Poras ◽  
Dario Raglione ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Feeding Tube ◽  
Tube Placement ◽  
Laparoscopic Technique ◽  
Complication Rates ◽  
Readmission Rates ◽  
Gastric Lumen ◽  
Gastrostomy Tube Placement ◽  
Totally Laparoscopic ◽  
The Cost

Laparoscopic feeding gastrostomy placement is a surgical operation that allows the feeding of malnourished patients through a tube that is placed in the gastric lumen. The benefits of an improved nutritional status in terms of improving clinical outcomes are well documented in the literature and consist in a reduction of the complication rates of the surgical patients, the length of hospital stay, the readmission rates, and a reduction of the cost of health services by reducing the morbidity or mortality. We present a totally laparoscopic technique of feeding tube placement.

scholarly journals Effect of Social Support and Marital Status on Perceived Surgical Effectiveness and 30-Day Hospital Readmission

2017 ◽  
Vol 7 (8) ◽  
pp. 774-779 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Victoria D. Vuong ◽  
Ankit I. Mehta ◽  
Raul A. Vasquez ◽  
...  
Keyword(s):  
Social Support ◽  
Hospital Stay ◽  
Marital Status ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Complication Rates ◽  
Readmission Rates ◽  
Outcomes Measures ◽  
Significant Difference ◽  
Patient Reported

Study Design: Retrospective cohort review. Objective: To determine whether higher levels of social support are associated with improved surgical outcomes after elective spine surgery. Methods: The medical records of 430 patients (married, n = 313; divorced/separated/widowed, n = 71; single, n = 46) undergoing elective spine surgery at a major academic medical center were reviewed. Patients were categorized by their marital status at the time of surgery. Patient demographics, comorbidities, and postoperative complication rates were collected. All patients had prospectively collected outcomes measures and a minimum of 1-year follow-up. Patient reported outcomes instruments (Oswestry Disability Index, Short Form–36, and visual analog scale–back pain/leg pain) were completed before surgery, then at 1 year after surgery. Results: Baseline characteristics were similar in all cohorts. There was no statistically significant difference in the length of hospital stay across all 3 cohorts, although “single patients” had longer duration of in-hospital stays that trended toward significance (single 6.24 days vs married 4.53 days vs divorced/separated/widowed 4.55 days, P = .05). Thirty-day readmission rates were similar across all cohorts (married 7.03% vs divorced/separated/widowed 7.04% vs single 6.52%, P = .99). Additionally, there were no significant differences in baseline and 1-year patient reported outcomes measures between all groups. Conclusions: Increased social support did not appear to be associated with superior short and long-term clinical outcomes after spine surgery; however, it was associated with a shorter duration of in-hospital stay with no increase in 30-day readmission rates.

Fistulotomy followed by anal sphincter reconstruction – indications, benefits and pitfalls of the method

Nowa Medycyna ◽  
2020 ◽  
Vol 27 (3) ◽  
Author(s):  
Małgorzata Kołodziejczak ◽  
Przemysław Ciesielski ◽  
Maja Gorajska-Sieńko ◽  
Magdalena Szczotko
Keyword(s):  
Surgical Intervention ◽  
Therapeutic Option ◽  
External Sphincter ◽  
Complication Rates ◽  
Anal Fistulas ◽  
Extensive Experience ◽  
Sphincter Reconstruction ◽  
Stool Incontinence ◽  
Seton Drainage ◽  
Continence Status

Fistula-in-ano is a disease which has challenged surgeons for centuries because of high postoperative complication rates including recurrences, and symptoms of postoperative gas and stool incontinence. The paper addresses the surgical method of fistula excision followed by sphincter reconstruction. The procedure is not new, but it has gained popularity in recent years. The primary indications for its use include complex high anal fistulas, posterior transsphincteric fistulas in patients with good baseline continence, and fistulas of “borderline” height, involving approximately 50% of the external sphincter mass. In cases of high and/or complex fistulas, the first stage of management is typically loose seton drainage to reduce the risk of infection. Prior to surgical intervention, it is important to assess the patient’s preoperative continence status. The paper presents the surgical technique of the intervention, outlines possible complications, and reviews the literature reporting the experiences of other authors who use the method. Fistulotomy followed by sphincter reconstruction is a bold surgical approach. It requires extensive experience in performing colorectal surgical procedures, and it is suitable for a selected group of patients. On account of possible complications including impaired postoperative gas and stool continence, the patient should receive appropriate information before surgery, and sign the surgical consent form. Fistulotomy followed by sphincter reconstruction is a good therapeutic option in patients with recurrent high anal fistulas unsuccessfully treated by other methods.

Bioresorbable  implants vs. Kirschner-wires in the treatment of severely displaced distal paediatric radius and forearm fractures – a retrospective multicentre study

2021 ◽  
Author(s):  
Marcell Varga
Keyword(s):  
Surgical Intervention ◽  
Complication Rates ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Kirschner Wires ◽  
Paediatric Patients ◽  
Fractures In Children ◽  
Significant Difference ◽  
K Wires ◽  
Wire Osteosynthesis

Abstract BackgroundDistal radius fractures are very common in paediatric patients. Severely displaced fractures may require surgical intervention. The gold standard surgical method is percutaneous K-wire osteosynthesis followed by immobilisation. Metal implants can be removed with a second intervention; however, these extra procedures can cause further complications. Several studies confirm the benefits of bioabsorbable implants for paediatric patients. The aim of this retrospective study was to compare the complication rates of displaced distal metaphyseal radius and forearm fractures in children operated on with K-wires versus a novel technique with bioresorbable implants.MethodsWe retrospectively reviewed 94 patients in three paediatric trauma centres who underwent operations due to severely displaced distal forearm or metaphyseal radial fractures between January 2019 and January 2020. The mean age was 8.23 (ranging from 5-12). 30 patients (bioresorbable group, BR-group) were treated with biodegradable PLGA implants (Bioretec®, ActivaPin®), 40 patients with one or two stainless steel Kirschner-wires (K-wires, Sanatmetal®) which were buried under the skin (KW I-group) and 30 children with K-wires left outside the skin. (KWII. Group). We examined the number of minor and major complications as well as the need for repeated interventions. Follow-up was at least one year.ResultsThere was no significant difference between the complication rates at the two KW groups (p = 0.241; Cramer’s V = 0.211), while the complication rate of the BR group was significantly lower. (p = 0.049; Cramer’s V = 0.293 and p = 0.002; Cramer’s V = 0.418 respectively). No later than half a year after the injury, no difference was observed between the functional outcomes of the patients in each group. One and a half years after the injury, no signs of growth disturbance were found in any of the children. No second surgical intervention was required in the BR group.ConclusionsSurgeries with bioresorbable intramedullary implants may have fewer complications than K- wire osteosynthesis in the treatment of severely displaced distal forearm fractures. The benefits are most pronounced in the first six weeks after surgery, reducing the number of outpatient visits and increasing the child's sense of comfort. As no second intervention is required, this can lead to significant cost savings. After half a year, there is no difference in the outcomes between the different surgical treatment strategies.

Timing of robotic hysterectomy after cervical excisional procedure

2019 ◽  
Vol 29 (7) ◽  
pp. 1110-1115
Author(s):  
Anna K. Melnikoff ◽  
David W. Doo ◽  
Alexander C. Cohen ◽  
Emily Landers ◽  
Christen Walters-Haygood ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
Complication Rates ◽  
Robotic Hysterectomy ◽  
Operative Complication ◽  
Operative Outcomes ◽  
Gynecology And Obstetrics ◽  
Estimated Blood Loss ◽  
Early Surgical Intervention

IntroductionWhile traditional teaching has been to wait 6 weeks between cervical excisional procedure and hysterectomy, studies have produced conflicting evidence, with data supporting a delay of anywhere between 48 hours to 6 weeks depending on surgical approach. Our study sought to evaluate if the time between cervical excisional procedure and robotic hysterectomy impacts peri-operative complication rates.MethodsA retrospective cohort of patients who underwent robotic hysterectomy from August 2006 to December 2013 for cervical dysplasia or International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA1–B1 cervical cancer at a single tertiary care center was performed. Patients were categorized into three groups: early surgical intervention (<6 weeks from excisional procedure), delayed surgical intervention (≥6 weeks from excisional procedure), and no excisional procedure. Secondary analysis was performed by hysterectomy type (simple vs radical). Peri-operative outcomes and complications were compared. Statistical analysis included Chi-square, Fisher’s exact test, and Wilcoxon rank sum test.ResultsA total of 160 patients were identified. Of these, 32 (20.0%) had early surgical intervention, 52 (32.5%) had delayed surgical intervention, and 76 (47.5%) had no excisional procedure. There was no difference between groups in complication rates, including average estimated blood loss (82 vs 55 vs 71 mL; p=0.07), urologic injury (0% in all groups; p=1.0), anemia (3% vs 0% vs 1%; p=0.47), infection (0% vs 2% vs 3%; p=1.0), vaginal cuff separation (0% in all groups; p=1.0), or venous thromboembolism (0% vs 0% vs 1%; p=1.0). Additionally, there were no differences in length of stay (p=0.18) or 30-day readmission rates (p=1.0). Finally, there were no significant differences in peri-operative outcomes when stratified by radical versus simple hysterectomy.DiscussionWaiting 6 weeks between cervical excisional procedure and robotic hysterectomy does not impact peri-operative complication rates. This suggests that the time from excisional procedure should not factor into surgical planning for those who undergo robotic hysterectomy.

Nationwide Analysis of Total Ankle Replacement and Ankle Arthrodesis in Medicare Patients: Trends, Complications, and Cost

2020 ◽  
pp. 193864002095018
Author(s):  
William A. Tucker ◽  
Brandon L. Barnds ◽  
Brandon L. Morris ◽  
Armin Tarakemeh ◽  
Scott Mullen ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Complication Rates ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Procedure Cost ◽  
Medicare Patients ◽  
Retrospective Comparative Study ◽  
End Stage

Background Surgical management of end-stage ankle arthritis consists of either ankle arthrodesis (AA) or total ankle replacement (TAR). The purpose of this study was to evaluate utilization trends in TAR and AA and compare cost and complications. Methods Medicare patients with the diagnosis of ankle arthritis were reviewed. Patients undergoing surgical intervention were split into AA and TAR groups, which were evaluated for trends as well as postoperative complications, revision rates, and procedure cost. Results A total of 673 789 patients were identified with ankle arthritis. A total of 19 120 patients underwent AA and 9059 underwent TAR. While rates of AA remained relatively constant, even decreasing, with 2080 performed in 2005 and 1823 performed in 2014, TAR rates nearly quadrupled. Average cost associated with TAR was $12559.12 compared with $6962.99 for AA ( P < .001). Overall complication rates were 24.9% in the AA group with a 16.5% revision rate compared with 15.1% and 11.0%, respectively, in the TAR group ( P < .001). Patients younger than 65 years had both higher complication and revision rates. Discussion TAR has become an increasingly popular option for the management of end-stage ankle arthritis. In our study, TAR demonstrated both lower revision and complication rates than AA. However, TAR represents a more expensive treatment option. Levels of Evidence: Level III: Retrospective comparative study

scholarly journals P336 Minimally invasive surgery is safe and feasible for luminal Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S323-S324
Author(s):  
M Nnaji ◽  
Y F Chin ◽  
O Pujji ◽  
B Wilkinson ◽  
S Mohan ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Minimally Invasive Surgery ◽  
Laparoscopic Surgery ◽  
Crohn's Disease ◽  
Open Surgery ◽  
Surgical Intervention ◽  
Laparoscopic Group ◽  
Readmission Rates ◽  
Inflammatory Bowel ◽  
Reoperation Rates

Abstract Background Crohn’s disease (CD) is an inflammatory bowel condition that still requires surgical intervention in about 70% of cases with laparoscopic surgery increasingly becoming the preferred approach. We present our experience in laparoscopic and open surgery for luminal CD in a DGH setting. Methods This was a retrospective analysis of data collected prospectively between 2008 and 2018. All patients with the diagnosis of CD who underwent a surgical intervention for luminal CD were selected and their demographic, clinical and surgical outcomes data analysed. Results 183 patients were identified. 162 (87%) underwent open and 21 (13%) laparoscopic surgery (p &lt; 0.0001). The median age was 48 years (16–82 years) in the open group and 42 years (16–64 years) in the laparoscopic group(p = 0.05). Male:female ratio was 1:1.2 in the open and 1:1 in the laparoscopic groups. Anastomotic leak rates were lower in the laparoscopic group (0% vs. 2.5%, p = 0.3520). Statistically significant lower readmission rates (9.5% in the laparoscopic, 18% in the open groups, p = 0.0255) and reoperation rates (14% in the laparoscopic and 18% in the open groups, p = 0.0108) were noted in the laparoscopic group. Conclusion Laparoscopic surgery is safe in patients requiring surgical intervention for Crohn’s disease with a notable trend towards improved clinical outcomes.

Surgery for Psychiatric Disorders

CNS Spectrums ◽  
2000 ◽  
Vol 5 (10) ◽  
pp. 43-52 ◽  
Author(s):  
G. Rees Cosgrove
Keyword(s):  
Surgical Intervention ◽  
Therapeutic Option ◽  
Treatment Plan ◽  
Psychiatric Rehabilitation ◽  
Rehabilitation Program ◽  
Psychiatric Disease ◽  
Complication Rates ◽  
Obsessive Compulsive ◽  
Stereotactic Techniques ◽  
Compulsive Disorder

AbstractThe modern therapeutic approach to most psychiatric diseases involves a combination of well-supervised psychotherapy, pharmacotherapy, and electroconvulsive therapy. Patients who fail to adequately respond to these modern treatment methods and remain severely disabled may be considered for surgical intervention. Cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy are the most common psychosurgical procedures performed today, with response rates in the 35% to 65% range. Modern stereotactic techniques have reduced complication rates, but controversy remains regarding the optimal surgical procedure. The major psychiatric diagnostic categories that might respond to surgery include treatment-refractory major affective disorders, obsessive-compulsive disorder, and chronic anxiety states. Surgery should be considered as one part of an entire treatment plan and must be followed by an appropriate psychiatric rehabilitation program. It should only be carried out by an expert multidisciplinary team consisting of a neurologist a neurosurgeon, and a psychiatrist with experience in these disorders. Surgical intervention remains a reasonable therapeutic option for select patients with a disabling psychiatric disease and may be underutilized.

scholarly journals Low-dose acetylsalicylic acid and bleeding risks with ventriculoperitoneal shunt placement

2016 ◽  
Vol 41 (3) ◽  
pp. E4 ◽  
Author(s):  
Maria Kamenova ◽  
Davide Croci ◽  
Raphael Guzman ◽  
Luigi Mariani ◽  
Jehuda Soleman
Keyword(s):  
Acetylsalicylic Acid ◽  
Antiplatelet Therapy ◽  
Low Dose ◽  
Perioperative Management ◽  
Morbidity And Mortality ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Bleeding Events ◽  
Vp Shunt ◽  
Shunt Placement

OBJECTIVE Ventriculoperitoneal (VP) shunt placement is a common procedure for the treatment of hydrocephalus following diverse neurosurgical conditions. Most of the patients present with other comorbidities and receive antiplatelet therapy, usually acetylsalicylic acid (ASA). Despite its clinical relevance, the perioperative management of these patients has not been sufficiently investigated. The aim of this study was to compare the peri- and postoperative bleeding complication rates associated with ASA intake in patients undergoing VP shunt placement. METHODS Of 172 consecutive patients undergoing VP shunt placement between June 2009 and December 2015, 40 (23.3%) patients were receiving low-dose ASA treatment. The primary outcome measure was bleeding events in ASA users versus nonusers, whereas secondary outcome measures were postoperative cardiovascular events, hematological findings, morbidity, and mortality. A subgroup analysis was conducted in patients who discontinued ASA treatment for < 7 days (n = 4, ASA Group 1) and for ≥ 7 days (n = 36, ASA Group 2). RESULTS No statistically significant difference for bleeding events was observed between ASA users and nonusers (p = 0.30). Cardiovascular complications, surgical morbidity, and mortality did not differ significantly between the groups either. Moreover, there was no association between ASA discontinuation regimens (< 7 days and ≥ 7 days) and hemorrhagic events. CONCLUSIONS Given the lack of guidelines regarding perioperative management of neurosurgical patients with antiplatelet therapy, these findings elucidate one issue, showing comparable bleeding rates in ASA users and nonusers undergoing VP shunt placement.

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