One-Year Follow-up of Elective Surgery Child Patients Receiving Preoperative Preparation

Objectives To evaluate outcomes after endovascular treatment of abdominal aortic aneurysms (AAA) involving the renovisceral arteries and to compare outcomes after fenestrated/branched endovascular aortic repair (f/b-EVAR), chimney/periscope EVAR (ch-EVAR), and bailout ch-EVAR. Methods A retrospective multicenter study including all patients with AAA involving the renovisceral segment, treated with f/b-EVAR, ch-EVAR, or bailout ch-EVAR, between 1 January 2005 and 30 June 2015, in three Swedish vascular centers. Patient charts were reviewed for data. Renovisceral stent graft patency was assessed on follow-up CT. Mortality was cross-checked against the Swedish Population Registry. Bailout ch-EVAR was defined as a perioperative decision of renovisceral endografting, as the artery was accidentally covered, or as the aneurysm neck sealing zone was considered inadequate. Results Of the 99 identified patients (76 men; mean age 74 years (range 58–89 years)), 68 underwent f/b-EVAR, 18 ch-EVAR, and 13 bailout ch-EVAR. Follow-up lasted for a median of 3.2 years (Q1, Q3 (2.1, 4.7 years)). Elective surgery comprised 87.9% ( n = 87) of the cases. Six patients died within 30 days, and the 30-day mortality after elective surgery was 4.6% (95% CI, 1.3%–11.4%) overall, 1.6% after f/b-EVAR (95% CI, 0.0%–11.4%), 15.4% after ch-EVAR (95% CI, 1.9%–45.4%), and 10.0% (95% CI, 0.3%–44.5%) after bailout ch-EVAR. During follow-up, there were 16 secondary interventions, of which 75% ( n = 12) were performed within six months after the primary intervention. Compared with f/b-EVAR, ch-EVAR was associated with a higher degree of type 1 endoleaks (1.5% vs. 22.2%, P = 0.001) and re-interventions during follow-up (13.2% vs. 33.3%, P = 0.046). The overall assisted target vessel patency was 96.1% (95% CI, 91.7%–98.6%) at one year and 95.2% (95% CI, 89.2%–98.4%) at two years. Conclusions Results after EVAR involving endografting of renovisceral arteries from three centers in Sweden with medium volumes are consistent with results previously reported from centers with larger volumes.

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Crucial Conversations for High Risk Populations Before Surgery: Advance Care Planning in a Preoperative Setting

10.21203/rs.3.rs-100950/v1 ◽

2020 ◽

Author(s):

Roma Gautam Patel ◽

Alexia Torke ◽

Barb Nation ◽

Ann Cottingham ◽

Jennifer Hur ◽

...

Keyword(s):

High Risk ◽

Advance Directives ◽

Advance Care Planning ◽

Elective Surgery ◽

Total Mortality ◽

Major Surgery ◽

Care Planning ◽

Advance Care ◽

One Year

Abstract Background: High-risk patients undergoing elective surgery may experience life-threatening complications. Preoperative assessment clinics provide an opportunity to conduct Advance Care Planning but it is unknown how often this is accomplished or subsequently needed for goals of care discussions. Objective: 1) assess the relationship between advance directives with readmissions and mortality at one year 2) qualitatively examine clinical events that occurred for patients who died during follow-up.Design: This was an observational cohort study conducted via chart review. Patients were followed for one year.Participants: Four hundred patients who were undergoing preoperative evaluation for elective surgery at two academic hospitals. Main measures: The prevalence of advance directives at the time of surgery, prevalence of advance directives in the electronic medical record during the one year follow-up period, readmissions and mortality at one year. Key Results: Three hundred and ninety patients were included. There were 102 (26.4%) patients were readmitted, which was not associated with having an AD on file. Seventeen (4.4%) filed an AD during follow-up. Twelve of 19 (63%) patients who died had an AD on file at the time of death. There was a significant association between having an AD at any time with mortality (chi-square p-value <0.001). Total mortality for the cohort was 4.9%. Of the 19 patients who died, seven (37%) underwent resuscitation, four of whom had an AD on file. Conclusions: A minority of patients who die within a year after major surgery have an AD, highlighting the missed opportunity to conduct advance care planning in a preoperative clinic.

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Inguinal hernias in patients of 50 years and above. Pattern and outcome

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/s0100-69912013000500005 ◽

2013 ◽

Vol 40 (5) ◽

pp. 374-379 ◽

Cited By ~ 1

Author(s):

Devajit Chowlek Shyam ◽

Amy Grace Rapsang

Keyword(s):

Inguinal Hernia ◽

Elderly Patients ◽

Hospital Stay ◽

Elective Surgery ◽

Uneventful Recovery ◽

Tension Free ◽

Inguinal Hernias ◽

One Year ◽

Operative Assessment

OBJECTIVE: to evaluate a one year experience with inguinal hernia repair, in patients of > 50years, with respect to the type of inguinal hernia, type of surgery, postoperative complications and recurrence. METHODS: a prospective descriptive study of patients (n=57) > 50 years operated for inguinal hernia during a one year period. Tension-free meshplasty and herniorrhaphy, using 3"x6" polypropylene mesh and 2-0 polypropylene suture, were performed in elective and emergency surgery respectively. Follow-up visits were scheduled at six weeks, three and six months postoperatively. RESULTS: the most representative age group was 61-70 years, and all patients were male. 52 (91.22%) patients had unilateral inguinal hernias, while five (8.77%) had bilateral hernias. In 50 (87.71%) patients, the hernia was uncomplicated, while seven (12.28%) patients presented with some complication such as obstruction or strangulation. Elective surgery was performed in 50 (87.71%) patients while seven (12.28%) patients were operated in emergency. Postoperatively, 50 (87.7%) patients had uneventful recovery, while seven (12.28%) patients developed some complications which were treated conservatively. Mean hospital stay was six days. One recurrence was observed and there was no peri/postoperative death. CONCLUSION: tension-free meshplasty and herniorrhaphy are safe, simple and applicable even in elderly patients after adequate pre-operative assessment and optimization. Although associated with longer hospital stay, the mortality rate is nil and complication as well as recurrence rate is low. Hence, timely repair is necessary in elderly patients even in those with comorbid conditions.

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Clinical Outcome of Surgical Diathermy in Elective Surgery-Prospective Randomized Controlled Tria

KYAMC Journal ◽

10.3329/kyamcj.v10i3.44417 ◽

2019 ◽

Vol 10 (3) ◽

pp. 143-146

Author(s):

Riaz Mahmud ◽

M Fardil Hossain Faisal ◽

Firoz Mahmud ◽

Munsur Miah ◽

Md Nahid Reza ◽

...

Keyword(s):

Clinical Outcome ◽

Hospital Stay ◽

Elective Surgery ◽

Wound Complication ◽

Skin Incision ◽

Postoperative Hospital Stay ◽

Cosmetic Outcome ◽

Group I ◽

One Year

Background: Recent studies suggest that surgical diathermy shows better clinical outcome in the context of incision time, wound related postoperative pain, postoperative wound infections, and length of postoperative hospital stay and cosmetic outcome of scar in cases of elective surgical patients. Objectives: Compare the efficacy and safety of surgical diathermy versus conventional surgical blade for making skin incisions in elective mid-line laparotomy and to evaluate weather cutting diathermy is an effective and better alternative to surgical blade incision. Materials and Methods: This prospective study was carried out in the department of surgery at BSMMU, Dhaka over a period of one year. Sample size was 64 with a follow up duration for 6 month. In Group I (D), skin incision was taken with diathermy, and in Group II (S), incision was taken with surgical blade. Results: Compared with a scalpel incision, cutting diathermy resulted in significantly shorter incision times and reduced post-operative wound related pain (P = <0·001), shorter duration of postoperative hospital stay (P = 0.003) with no differences in the wound complication rate and cosmetic outcome of scar. Conclusions: The study has demonstrated that surgical cutting diathermy is a safe and effective method to make skin incisions in elective surgery KYAMC Journal Vol. 10, No.-3, October 2019, Page 143-146

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