scholarly journals TP10.2.8Adaptation in providing renal access surgery service in response to covid-19 pandemic- a single centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
S A Mir ◽  
Avneesh Kumar ◽  
Nathan Chidambaram ◽  
Ravi Pararajasingham
Keyword(s):  
Discharge Rate ◽  
Postoperative Outcome ◽  
Day Surgery ◽  
Outcome Data ◽  
Fistula Formation ◽  
Single Centre ◽  
Av Fistula ◽  
Same Day Discharge ◽  
Complex Fistula ◽  
Access Surgery

Abstract Aim Evaluate impact of Covid-19 pandemic on renal access surgery and changes in practice towards counteracting limitations to provide safe and effective peritoneal and haemodialysis. Methods Retrospective review of procedures for dialysis in ESRD patients from institutional databases in a single centre was carried out. Patients undergoing peritoneal catheter insertions (PD) or AV fistula formation (HD) between March 2020 and October 2020 were compared with similar period in 2019. Demographic, procedure and postoperative outcome data was collected. Results Between March and October 2019, 143 combined PD and HD procedures were performed compared to 98 in the same time period in 2020. The mean age of patients was 65 ± 15 years and 62 ± 12 years, respectively. In 2020, 26 patients had PD catheter insertion and 22 patients in 2019. 18% of these were performed laparoscopically in 2019 compared to 33% in 2020. The same day discharge rate increased to 34% from 22%. Patients having complex fistula procedures including basilic vein transpositions and grafts requiring overnight stay dropped from 83% patients (n = 23) to 71% (n = 7) in 2020. In 2019, 80% (n = 49) patients had radio-cephalic fistula performed as same day procedure increasing to 98% (n = 22) in 2020. Day-surgery unit utilisation increased from 55% to 71%. Same day discharge rate increased from 53% to 66%. There were no readmissions. Conclusions Adaptations in terms of increased support for same day surgery even for complex renal access procedures has improved service. A greater proportion of renal access service can be same day procedures avoiding inpatient stay.

scholarly journals Questionable safety of thyroid surgery with same day discharge

2012 ◽  
Vol 94 (8) ◽  
pp. 543-547 ◽  
Author(s):  
HE Doran ◽  
J England ◽  
F Palazzo
Keyword(s):  
Surgical Procedures ◽  
Thyroid Surgery ◽  
Evidence Base ◽  
Day Surgery ◽  
Hospital Environment ◽  
British Association ◽  
Outpatient Basis ◽  
Day Case ◽  
Increased Risk ◽  
Same Day Discharge

INTRODUCTION Over the last two decades increasing numbers of surgical procedures have been performed on an outpatient basis. In 2000 the National Health Service in England set the target of performing 75% or more of all elective surgical procedures as day cases and in 2001 the British Association of Day Surgery added thyroidectomy to the list of day case procedures. However, same day discharge following thyroidectomies has been adopted by only a very small number of UK centres. The aim of this review was to establish the evidence base surrounding same day discharge thyroid surgery. METHODS The British Association of Endocrine and Thyroid Surgeons commissioned the authors to perform a review of the best available evidence regarding day case thyroid surgery as a part of a consensus position to be adopted by the organisation. A MEDLINE® review of the English medical literature was performed and the relevant articles were collated and reviewed. RESULTS There are limited comparative data on day case thyroid surgery. It is feasible and may save individual hospitals the cost of inpatient stay. However, the risk of airway compromising and life threatening post-operative bleeding remains a major concern since it is not possible to positively identify those patients most and least at risk of bleeding after thyroidectomy. It is estimated that half of all post-thyroidectomy bleeds would occur outside of the hospital environment if patients were discharged six hours after surgery. CONCLUSIONS Same day discharge in a UK setting cannot be endorsed. Any financial benefits may be outweighed by the exposure of patients to an increased risk of an adverse outcome. Consequently, 23-hour surgery is recommended.

Fifty years of hemodialysis access literature: The fifty most cited publications in the medical literature

Vascular ◽  
2017 ◽  
Vol 26 (1) ◽  
pp. 75-79
Author(s):  
Edvard Skripochnik ◽  
David J O’Connor ◽  
Eric B Trestman ◽  
Evan C Lipsitz ◽  
Larry A Scher
Keyword(s):  
Medical Literature ◽  
Chronic Hemodialysis ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
Av Fistula ◽  
Hemodialysis Catheter ◽  
Number Of Patients ◽  
Number Of Publications ◽  
Modern Era ◽  
Access Surgery

Objectives The modern era of hemodialysis access surgery began with the publication in 1966 by Brescia et al. describing the use of a surgically created arteriovenous fistula. Since then, the number of patients on chronic hemodialysis and the number of publications dealing with hemodialysis access have steadily increased. We have chronicled the increase in publications in the medical literature dealing with hemodialysis access by evaluating the characteristics of the 50 most cited articles. Methods We queried the Science Citation Index from the years 1960–2014. Articles were selected based on a subject search and were ranked according to the number of times they were cited in the medical literature. Results The 50 most frequently cited articles were selected for further analysis and the number of annual publications was tracked. The landmark publication by Dr Brescia et al. was unequivocally the most cited article dealing with hemodialysis access (1109 citations). The subject matter of the papers included AV fistula and graft (9), hemodialysis catheter (9), complications and outcomes (24), and other topics (8). Most articles were published in nephrology journals (33), with fewer in surgery (7), medicine (7), and radiology (3) journals. Of the 17 journals represented, Kidney International was the clear leader, publishing 18 articles. There has been an exponential rise in the frequency of publications regarding dialysis access with 42 of 50 analyzed papers being authored after 1990. Conclusion As the number of patients on hemodialysis has increased dramatically over the past five decades, there has been a commensurate increase in the overall number of publications related to hemodialysis access

Transanal endoscopic microsurgery as day surgery - a single-centre experience with 500 patients

2018 ◽  
Vol 20 (10) ◽  
pp. O310-O315 ◽  
Author(s):  
C. J. Brown ◽  
J. Q. Gentles ◽  
T. P. Phang ◽  
A. A. Karimuddin ◽  
M. J. Raval
Keyword(s):  
Transanal Endoscopic Microsurgery ◽  
Day Surgery ◽  
Single Centre ◽  
Single Centre Experience ◽  
Endoscopic Microsurgery

A Rare Case of an Aneurysm of the External Iliac and the Common Femoral Vein

1996 ◽  
Vol 11 (1) ◽  
pp. 34-38 ◽  
Author(s):  
N. Labropoulos ◽  
S. K. Volteas ◽  
A. Al Kutoubi ◽  
A. N. Nicolaides ◽  
A. O. Mansfield
Keyword(s):  
Iliac Fossa ◽  
Femoral Vein ◽  
Oral Anticoagulants ◽  
Fistula Formation ◽  
Compression Stockings ◽  
Vein Wall ◽  
Av Fistula ◽  
Common Femoral Vein ◽  
Acute Thrombosis ◽  
The Right

Objective: To report a case of an external iliac – common femoral vein aneurysm and review the literature on the subject. Design: Case report. Setting: Academic Vascular Surgery and Radiology Units, St Mary's Hospital, London, UK. Patients, Interventions and Results: The aneurysm occurred in a 34-year-old woman and was diagnosed with venography, duplex scanning and magnetic resonance venography. It underwent acute thrombosis and, as the thrombus was well organized and extensive, thrombectomy was not possible. The patient was treated with standard heparin followed by oral anticoagulants for 5 months. Thirty months after the operation the right calf remains swollen but soft and non-tender and the patient is currently treated with grade II full-length compression stockings. Since there were no findings of vein compression or malignancy it seems that the formation of the aneurysm resulted from a congenital weakness of the venous wall. Conclusions: The most common presentation of these aneurysms is of a mass of the abdomen or the iliac fossa, while thromboembolism is not uncommon. The main causes are arteriovenous (AV) fistula formation and congenital weakness of the vein wall. For the first the preferred treatment is AV fistula ligation while for the rest ligation with or without vein reconstruction has been successfully used.

scholarly journals Erratum to: Same-day discharge after craniotomy for supratentorial tumour surgery: a retrospective observational single-centre study

2017 ◽  
Vol 64 (3) ◽  
pp. 345-346
Author(s):  
Lashmi Venkatraghavan ◽  
Suparna Bharadwaj ◽  
Karolyn Au ◽  
Mark Bernstein ◽  
Pirjo Manninen
Keyword(s):  
Single Centre ◽  
Centre Study ◽  
Same Day Discharge ◽  
Single Centre Study

Cervical Laminoplasty as a Management Option for Patients With Cervical Spondylotic Myelopathy

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 272-277 ◽  
Author(s):  
Anthony L. Petraglia ◽  
Vasisht Srinivasan ◽  
Michelle Coriddi ◽  
M. Gordon Whitbeck ◽  
James T. Maxwell ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Medical Center ◽  
Demographic Data ◽  
Adult Population ◽  
Postoperative Outcome ◽  
Outcome Data ◽  
Consecutive Series ◽  
Cervical Laminoplasty ◽  
Presenting Symptoms

Abstract BACKGROUND Cervical spondylotic myelopathy (CSM) is one of the leading causes of spinal cord dysfunction in the adult population. Laminoplasty is an effective decompressive procedure for the treatment of CSM. OBJECTIVE We present our experience with 40 patients who underwent cervical laminoplasty using titanium miniplates for CSM. METHODS We performed a retrospective review of the medical records of a consecutive series of patients with CSM treated with laminoplasty at the University of Rochester Medical Center or Rochester General Hospital. We documented patient demographic data, presenting symptoms, and postoperative outcome. Data are also presented regarding the general cost of constructs for a hypothetical 3-level fusion. RESULTS Forty patients underwent cervical laminoplasty; all were available for follow-up. The mean number of levels was 4. All patients were myelopathic, and 17 (42.5%) had signs of radiculopathy preoperatively. Preoperatively, 62.5% of patients had a Nurick grade of 2 or worse. The average follow-up was 31.3 months. The median length of stay was 48 hours. On clinical evaluation, 36 of 40 patients demonstrated an improvement in their myelopathic symptoms; 4 were unchanged. Postoperative kyphosis did not develop in any patients. CONCLUSION The management of CSM for each of its etiologies remains controversial. As demonstrated in our series, laminoplasty is a cost-effective, decompressive procedure for the treatment of CSM, providing a less destabilizing alternative to laminectomy while preserving mobility. Cervical laminoplasty should be considered in the management of multilevel spondylosis because of its ease of exposure, ability to decompress, effective preservation of motion, maintenance of spinal stability, and overall cost.

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